Epidurals for Pain Relief in Labor

It is very common in the birthing culture of the United States for a large amount of women to choose epidural anesthesia as the primary form of pain relief in normal labor and birth.  The Listening to Mothers Survey II reports that 76% of the mothers surveyed used an epidural during their labor.  Epidurals are often encouraged by some obstetricians and midwives.  Sometimes the encouragement to seek this form of pain relief comes from our own mothers or partners who don’t want us to suffer.  Then, again, some women choose it of their own accord because – “Why not?  Why should I feel that pain if I don’t have to?”  It’s true.  While natural, drug-free childbirth can be a very rewarding opportunity, it is our individual choice.  We should most definitely be thankful that we have the epidural as a relatively safe option for pain relief in childbirth, especially when we are facing a situation that may be outside of what is normal for labor and birth.  If you do choose an epidural, what does that mean for you?  Do you still need to prepare yourself for labor and birth through childbirth education classes?  Should you still consider having an extra support person aside from your partner, or hiring a doula?  What things should you consider before deciding if an epidural is the right option for you?

Who Should Consider Epidural Anesthesia?

Normal labor and birth is the most safe when medical interventions are only used out of medical necessity.  This is because with each intervention a mother chooses for herself (elective), or needs to ensure she is able to birth safely (medical necessity), there are risks as well as benefits.  An intervention becomes the safer choice when the benefits outweigh the risks of the medicine or procedure for either yourself or your baby.  Your care provider should inform you of all the risks and benefits of any intervention you are considering or will need before performing that procedure.  (In some situations, medical emergency might limit the time in which this sort of discussion can take place.  This is why it is important you inform yourself of procedures and discuss them with your care provider before the birth.  Childbirth education classes can help you learn the risks and benefits of the most common medical interventions for birth.)

Given this information, when might it be a good option to choose an epidural without there being a medical emergency/necessity?  Women who are fully supported through labor by their partner, family, friends, and/or a professional labor support person (doula), have prepared themselves mentally and physically, and have a care provider who is comfortable with and supportive of drug-free childbirth are not only perfectly capable of birthing free of narcotic or anesthesia, but can also find the experience empowering and extremely joyful.

Drug-free hospital birth with a supportive obstetrician.

It does not require a high threshold for pain to give birth without the use of drugs.  It doesn’t require us to be Hercules – just a woman. 🙂  Our female bodies are built to withstand normal, vaginal childbirth.  However, if the mother is extremely fearful despite educating herself about the process of birth and doesn’t feel she can cope with the intensity of labor to the detriment or her or her baby’s health, if she has experienced the trauma of physical, sexual, or emotional abuse, or if she simply chooses to accept an epidural anesthetic, then that is her right as a birthing woman.  The most important thing for the laboring mother is that she feels what she wants to feel, does not suffer during the birth of her baby, and has made her own informed, supported choices for her birth. 

Other situations might arise where an epidural might not be a necessity, but a wonderful option for the laboring mother. 

  • labor is prolonged and the mother is tired or unable to rest, epidural could provide the relief she needs to regain the strength she needs for a vaginal birth.
  • the mother is not tolerating labor well, and is not finding relief in any of the comfort measures she and her support persons have tried.
  • malpostitioning of the baby has intensified labor (or caused extended back labor ) and the mother has grown weary and needs a break.
  • the mother required an induction of labor (induction increases the strength and duration of contractions beyond that of natural labor) and is finding she is unable to cope with the contractions.

Medical reasons an epidural would be a good choice are several.  C-section births make epidural a good choice as the mother can be awake, recover fairly quickly from the numbness, and is then able to be present for her baby’s first moments of life.  Again, many mothers who require induction find epidurals are necessary for their comfort.  There might be other situations unique to you that would make epidural a good choice, and in some situations would cause you not to be a candidate for an epidural.

We Know the Benefits of Epidural 🙂  What are the Risks?

The risks of epidural are many, though in most cases it is one of the safest forms of medical pain relief available to the laboring woman.  The most common risk is a dip in the mother’s blood pressure which can be remedied through changing the mother’s position and medications.  Women using epidural anesthesia often require IV fluids and continuous electronic fetal monitoring.  This limits the woman’s mobility and restricts her to the bed in most cases.  This means the woman must work against gravity to bring the baby through the birth canal, instead of working through labor in various upright positions.  During the pushing stage, mothers who have not “labored down” (allowed the epidural to wear off somewhat) from their epidural might not feel the urge to push, would require coached pushing, and in turn be at a greater risk for pushing too hard, increasing their risks of tears to the perineum, or the need of episiotomy.  The inability to feel her body enough to push effectively could be a possibility, that might require forceps or vaccum aided birth.  C-section is also a possibility. 

Some women are surprised by the sensations from placing the epidural, which can vary from pain-free pressure to intense pinching.  In some odd situations an epidural might be effective only on one side of the woman’s body, leaving the other side completely without relief.  Also, some women will experience spinal headaches that can last for sometime.

Read more about epidural pain relief from Robin Weiss, LCCE and author of the About.com pregnancy/childbirth column.

Is there any reason to participate in a childbirth education class if I plan on asking for an epidural?

Absolutely!  Childbirth education is not only for those seeking to give birth naturally.  Sure, childbirth education will equip you with comfort techniques for mothers who do want to give birth naturally, but many of the techniques are useful for all pregnant women and some especially to those who will need interventions for birth.  You will also learn more about medical interventions for birth, like the epidural, and will discuss the risks and benefits of the most common.  This can help you talk with your care provider more about those you are considering.  Also, despite whether or not you choose to give birth with or without drugs, it is very helpful to know and completely understand the process of labor and birth.  It can help reduce any fear you might be having regardless of your birth plans.  Childbirth education covers this in detail.  Many classes also cover basic newborn care and breastfeeding.  Some interventions will require you to take a different approach to your early parenting as you recover from them.  Your childbirth educator can help you with ideas to support early breastfeeding and newborn care.

For more reading…

Epidural – BirthingNaturally  

Epidural and Spinal: Options for Labor Pain – Childbirth Connection

While I am a happy supporter and advocate of drug-free childbirth, I recognize and support most importantly the mother’s right to make her own choices for how she will give birth.  Among these choices is the use of narcotics and anesthesia for pain relief.  We never know when it might be us who is the one in need of one of these medical interventions and they are a great blessing to us, or even, when we might surprise ourselves in our strength and the abilities of our mind and body and give birth without drugs when we had planned to use them.  When we are the ones making informed decisions, there should be no guilt in the making of them.  We aren’t weak because we choose pain medication.  We aren’t giants because we did not.  We are women giving birth as we see fit.  Only we know what is right for us, and with accurate information, the help of our care providers and support persons, and our motherly intuition, we will be the best decision maker for a healthy birth, however that may result. 

Many happy days to you and yours,

Kelli

 

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About Kelli

I am Kelli B. Haywood, LCCE, a childbirth educator certified through Lamaze, a birth doula, and prenatal yoga instructor. My two little girls light my life. I am the wife of artist, musician, and teacher - John Haywood.
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One Response to Epidurals for Pain Relief in Labor

  1. Angela says:

    Kelli,
    I found this blog post by doing a search for information on epidurals for my own blog. I am VERY impressed by how well written this post is, and I thank you for taking the time to write it. I was having trouble finding information on epidurals that did not lean towards ridiculing those who opted for it, or that minimized the risks entirely. Although a natural birth advocate, I am first and foremost a birth doula who supports the woman’s right to choose. I couldn’t have written it better myself! I quoted you on my blog, and am very happy to be able to share this link with my clients.
    Sincerely,
    Angela

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