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Pain relief and pregnancy: opting for an epidural
Filed under: Your Pregnancy
In approximately two weeks (March 31 is the d-day) I will be a new mommy. That said, amidst all the layette options, getting my house and life in order and trying to come up with something constructive for my husband to do besides stew I have the wonderful and strange option of determining whether or not I want pain management during my labor. In other words, do I want the drugs or not?
Interestingly enough, much like with the breastfeeding conversation, the topic of epidurals is a REALLY hot one. Some believe natural child birth is the only way to go. This means no drugs. This means lots of pain. This means, however, that you have the baby the way everyone else did before someone got the bright idea to stick a needle in your spine and numb at least part of you from the waist down. Since the beginning of human time women have given birth without the aid of medication and somehow the species has survived.
Others, like my anesthesiologist, believe that there is no reason whatsoever for a woman to endure such pain when options are available to manage said pain while still allowing the woman to participate in the actual birth of her child. Contrary to the old days, when women were basically knocked out and woke up to their little one, epidurals no longer cut off all feeling from the waist down, allowing modern women the advantage of being able to feel the pressure and some pain in order to assist in squeezing out their bundles of joy instead of relying on the healthcare professionals alone to do it for them. This is known as a walking epidural, or, as my anesthesiologist likes to joke, an "epidural lite" (you know, like a Bud Lite).
Just listening to my grandmother, who gave birth to my mom in her mother's rural home way back when, was almost enough to make the decision for me. I swear she informed me they put a cloth doused in ether over her mouth and that was it, except for the writhing and screaming and whatnot. According to grandma the cloth was only as good as long as she could keep it over her mouth, which was for about ten seconds after which she had a contraction and threw the cloth clear across the room. The doctor was there of course, and both grandma and my mother made it through the entire process intact and in good health. Otherwise I guess I wouldn't be here to write about it.
Still, I wanted to know what the options for pain relief were before making a decision, and more importantly what drawbacks there might be. Would getting an epidural possibly cause harm to me or my baby? Would it keep me from being able to experience fully the birthing process? The answers to those two questions, by the way, are no.
The more I read the more confused I became. So I turned to a professional, by way of a free seminar held at NYU, the hospital where I plan on birthing my son. I say "plan" because I live in Brooklyn and the hospital in in Manhattan on the East Side. One never knows what could happen on the long strange journey between the two.
It turns out there are a LOT of myths out there concerning pain management. For example, one woman at the seminar asked if there was ever a point at which it was too late to get an epidural. Apparently the only time it truly is too late is once you've had the baby!
During the seminar I learned that getting an epidural is up to me and my obstetrician (there are certain conditions under which it is not advisable to receive an epidural. That said, other pain management options exist for such conditions should you desire such treatment.). I was informed of exactly how one is administered--it's not as scary as I thought--and even got to play with an epidural wire. It looks essentially like an i-Pod headphone wire.
Patients these days have a lot more individual control over their pain management than in the old days, which I found refreshing. Literally they hook you up to the drugs and you can give yourself a squirt whenever you feel you need it. It should be noted here you CANNOT overdose on the medicine as it is controlled for a release of every ten minutes. this means that you can click away all you want, but you're only going to get a shot of the good stuff every ten minutes.
If your hospital doesn't offer a seminar to separate myth from fact like mine does, take heart. The world wide web does have some useful info to offer, and in particular this article which I found most helpful. Essentially most of what I learned at the seminar can be found in this article, with one major exception which I think is important to note: At the seminar I was informed that even if I did get an epidural I would be able to move around because I would be getting an epidural lite. Walking around wouldn't be a snap, but it would be doable. Whether or not you wish to move around, given this is one of the last opportunities you have pre-motherhood to just sit there, is up to you.
If you decide to forgo the drugs and have the baby au natural, there are any number of ways to go about relieving pain, including breathing exercises, massage, heating pads and warm water. Remember, as I said before, women have been having babies this way for centuries and everything seems to have turned out OK: we're all still here!
Before making any decisions that could affect your well being or that of your baby, it is imperative that you gather all the facts and consult a professional to help make sense of them. Whether or no you choose to get an epidural is up to you, and your decision should be respected. Whatever it ends up being, make your decision an informed one.
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ReaderComments (Page 1 of 3)
3-19-2007 @ 10:39AM
Nicole said...There ARE side effects and potiential problems for both the baby and the mother when an epidural is chosen. Of course a hospital is going to downplay those risks b/c it's less work for the staff (and more $$$ for the hospital) to have more laboring women choosing to use an epidural. Some potiental risks include: increased length of labor, drop in maternal blood pressure and fetal heart rate, maternal fever, lingering back pain, spinal headache and more. Some recent medical studies have shown that epidural use makes is more difficult to get breastfeeding off to a good start. Epidurals can also lead to a cascade of medical interventions. Labor augmentation, instrumental delivery of the baby and cesarean section are more common in women that choose an epidural. I believe that every woman has the right to choose how she wants to labor, but without full disclosure about the benefits and risks she is unable to made an educated choice.
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3-19-2007 @ 9:53AM
mamaloo said...In my line of work, I have to talk about epidurals a lot (I'm a doula and a childbirth educator). Your post brought to mind a number of considerations women need to take into account when researching epidurals:
1) Epidurals and the narcotic cocktail that are used with them have never been tested on fetuses and newborns. NEVER.
2) In our society, when it is recommended that a woman foregos any and all medications during pregnancy unless absolutely medically necessary (and that doesn't even take into account the recommendations against things like deli meats, soft serve ice cream, sushi, fish, alcohol, caffeine...), I find it incongruous that epidurals are pushed onto women so readily.
3) In an age of hyperawareness of the effects of foods and chemicals on the bodies of our children, I find it incongruous that epidurals are so widely used and recommended on the bodies on non-consenting babies.
4) The drugs used in epidurals absolutely inhibit the normal flow of hormones and chemicals in the woman and baby's body, dramatically increasing the risk of complications during labour, birth and the newborn phase.
5) Taking a class on the realities of drug use during labour from a hospital seems naiive to me. They have a strong bias in influencing their future patients to opt for epidurals. It seems like asking a tobacco company to explain the real deal on the dangers or lack thereof of smoking.
I struggle all the time with balancing what I know about narcotic use during labour and honouring those women who prefer to use narcotics throughout their labour. Time and time again, and more and more as I learn further about birth and interventions, I see the widespread elective use of epidural as a problem.
I wonder why it is that North American women are so phobic about birth?
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3-19-2007 @ 10:19AM
Lisa J. said...I think it's totally personal. I had a full-on epi and had a great experience and absolutely NO complications. Medicine has evolved in virtually every other realm, so why not with birth? If you don't want to chose it, then that's your decision, but I personally didn't feel the need to suffer like women did in the dark ages in order to have my baby! And I know myself. I am narrow-hipped, my daughter was a big baby, and I have an extremely low pain tolerance. The mere thought of going natural made me dizzy. Yes, there are potential complications with an epi, but there are always complications with birth in general--lets not forget that childbirth used to be one of the leading causes of death for women.
What happens to the body in birth is amazing, but it can also be painful and scary. Everyone is different. I don't expect anyone else to adopt my opinion and wish my choice could be respected.
Jennifer, do what's in your heart and remember that many, many babies have been born natural and with an epi, so I'm sure yours will be fine either way. Just shut out the hype from both sides (including the idea that "true" motherhood should be equated with suffering), keep talking to your doctor (he/she is the one with the medical degree, after all), reading up on your options, and trust your ability to make the right choice for you and your family. And don't forget to consider what you need and want from the birthing process! You DO matter in all this, after all. Best of luck!
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3-19-2007 @ 10:37AM
tammy said...I also had a full-on epi and had no complications. In retrospect, I am so gratefull that I had the epi. I was fully awake and aware. I was able to experience my daughter's birth and look back on it with fond memories. Had I been in racking pain the whole time, I would not have had the same experience. And there was SOME pain, I wasn't completely numb.
I am a total sissy and was petrified of delivery. I almost opted for a C-section because of my fear. I am so glad that I had the option of an epi and because of that I chose to deliver vaginally.
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3-19-2007 @ 10:53AM
Leian said...I think this is ultimately up to you. With my first child, I made it my business to learn as much as I could about it ahead of time but I did not go into it saying I was absolutely NOT going to have one or that I HAD to have one. I let my pain decide for me. I did end up having one, which helped with my 22 hours of labor. (My daughter was absolutely fine throughout the entire labor and showed no reaction to the medication.) I have friends who have gone natural and I applaud them. But I don't look down at all on women who do have them. While I agree that we all need to be educated about the risks involved, to say that women have been doing this for centuries without pain management so therefore we should today, is ridiculous. People also used to get amputations performed and teeth pulled with nothing but a shot of whiskey or being physically knocked out, but I don't see anyone advocating that those things be performed the same way today. There is nothing inherently wrong with taking advantage of medical advances. As for "foisting" the drug on the baby, don't we also do that with vaccinations? (Which I know many people, myself included, have some issues with too...)
At the end of the day, educate yourself as well as possible. Look up information online, discuss it with your doctor, midwife, doula and anyone else. Be sure that they are not "foisting" their opinions on you but sharing factual information. And then go in with an open mind. Maybe you won't need it and that would be fabulous. And maybe you'll want to try other natural pain relief options before going that route. I know I do wish that other options had been more readily discussed but I delivered in a hospital that caters to a very wealthy segment of society that doesn't believe in pain, so epidurals are common there. The second time around, I am going to push more for other methods of relief before considering the epidural route. If you decide you absolutely will not do it, I bet that baby will come out just fine. But if you do need it, and know any risks going in, the chances are your baby will be fine, and you are no less a woman for having chosen to relieve the pain a little. I have horrific menstrual periods and I take herbal medicines but sometimes I need a damn Advil or 4. I see nothing wrong with doing things - in moderation - to make the pangs of womanhood a little easier on my body and soul.
Good luck.
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3-19-2007 @ 10:30AM
SKL said...I'm not an expert in this, but a nurse close to me noted that in births where an epidural has been used, newborns are much more groggy and helpless; where epidurals have not been used, they are quite strong, active, and alert. An epidural has a very significant effect on the newborn. For that reason alone, I would be very reluctant to choose an epidural.
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3-19-2007 @ 5:19PM
Jennifer Jordan said...To Leian: Thanks for your comments! I was actually trying to say that if a modern woman doesn't want pain relief there's nothing wrong with that since her predecessors didn't have it available to them. Sorry for the confusion.
And I agree with you about the shot of whiskey--thank goodness we have other options available! :)
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3-19-2007 @ 10:39AM
Mammacheryl said...I had a full-on epi with the birth of my son. I got to the hospital a few minutes after my water broke, and within ten minutes, I was in labor. I honestly don't remember the next two hours. I was in such pain, and I was panicking. Once I had the epidural in, I was calm and relaxed, and I had a much better time. Delivery itself hurt like hell. Epis don't take away all the pain. For my second due in November, I'll see how long I can go without the epi, but I'm not going to force myself to labor without it. I don't tolerate pain very well, and I'd like to be concious for the birth of my baby.
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3-19-2007 @ 5:29PM
Jennifer Jordan said...Actually everything I've heard and read to date--and it's beebn a LOT because I've been doing my homework--negates the theory that an epidural leads to C-sections.
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3-19-2007 @ 12:40PM
Pavlina said...Shame on you for writing this article. Getting any sort of anesthetic is a major decision, especially when you are carrying a baby. I find your light-hearted decision to have an epidural confusing. These are powerful drugs, and as the first commenter pointed out, they have NEVER been tested on fetuses, so it is just plain incorrect to state there is no danger. I also find it confusing that you went to the hospital to get information on informed drug choices. Not exactly a bias-free source of information.
I also find it completely bewildering that a previous commenter also said that she was so terrified of pain that she almost opted for a C-section. So switch one kind of pain for another?
Childbirth is something that is natural. Once you understand how to manage it, the pain is negligible. I say that with a straight face. Women have been doing this for centuries and no-one has died FROM THE PAIN ITSELF yet. I am very small with very narrow hips and yet my body has been able to push both of my children out with no issue.
I would encourage women to explore all their opportunities early in their pregnancy. There are many drug-free methods to control the "pain" of child birth, but most of them do require months of exercise.
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3-19-2007 @ 11:09AM
courtney said...Ok lets see I had a full epi with my first son. While I had no serious complications I feel like I missed a lot because yeah you are awake but I felt drunk. I also think it took a lot longer to recover. My second son I did with out drugs. But I acutally went into labor by my self(which I didn't with my first)and everything progressed as it should. Contractions were actually manageable, I mean they hurt but I was able to work through them. Then my water broke and it became a whole different world-pain like no other. But the need to push came fast and that felt like a relief. It was like once I was fully in the middle of it doing it without pain meds it was ok and not scary. After my second son was born I was up and about actually feeling good the same day. It's definitely a personal choice, but since that experience I always suggest that if you don't have any complications give it a try with out-you'd be amazed at what your body and mind can do :)I wish you an easy and fast delivery!
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3-19-2007 @ 11:39AM
Anonymous said...I fully intended to only use natural pain relief and give birth at the birthing center. After almost a full day of labor pains, I go the epidural and it was GREAT!! I really enjoyed the birthing process after that. I had plenty of energy to push - cuz with a good epidural you still feel the pushing - and I ended up with only one stitch.
My baby was alert and took to breastfeeding like a champ. I don't know anyone who chose the epidural and had problems breastfeeding as a result of the epidural. I know plenty of people who didn't have pain relief and had difficulty breastfeeding, though. I'd like to see some real scientific studies of this rather than random anectdotal evidence.
I'm due again soon and I have every intention of having the epidural again.
I get really angry when these macho games are played about pain relief in childbirth.
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3-19-2007 @ 11:42AM
Katrina said...Its all up to you!!! Personally I had a full epi with my 1st. I had it in for a very LONG 28 hrs and at first it was wonderful, but after so many hours it started to drive me crazy b/c I am that person who had to be able to move and feel her own legs!! I finally had a c/s due to size, position and cervic swelling.
2nd time around I had a walking epi and LOVED it. I will be getting another one when I have my 3rd later this yr. I could feel things but was not in pain. I had a VBAC and it didnt hurt but I always knew when to push. It was the best thing ever. I will say however that there was NO way I could ever walk on it. Yes, I could move my legs sort of but even the midwife said its not something you'll actually be able to walk with. It would be have been nice but if I tried I would have fallen on my bum!
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3-19-2007 @ 11:49AM
Lil Liberal said...If the hospital is NY Presbytarian or Lennox Hill, be aware that they're c-section happy. They love to say that the woman is "exhausted". (Code for "we need your room and you're just not progressing fast enough to make this whole venture profitable.") Since epidurals can increase the chance of a c-section, it's something to think about.
I went the no-meds route. It wasn't that bad. It was intense, but as long as you're not shy about making grunting and groaning sounds (open-mouthed relaxed-faced low-pitched sounds feel good/relieve the pain, screaming or squinching your face up intensifies it.) The only memory of pain that I have is when the nurse made me lay down to insert an IV. Other than that, the most annoying thing was the exhaustion.
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3-19-2007 @ 11:56AM
Lil Liberal said...btw, I have an extremely low pain tolerance. I scream when I stub my toe, regularly freak out at dental appointments that involve nothing more than a rigorous cleaning. Yet, labor and birth only had me screaming three times- each when my concentration was interrupted by my mother in law or a nurse. birth pains are unlike any other pains, and are both more intense and less intense. As long as I followed the pain and kept in motion, I didn't feel pained. It was only when the contractions "caught up to me" when I was distracted, that I felt pain.
I had pretty heavy contractions, too. I went from 7-10 centimeters in 45 minutes (it usually takes a first time mom 1 hour per cm to dilate). Fast dilation is more painful and more intense than slower more gradual dilation. I should have been screaming. Instead I was bickering with the nurses that were trying to get me to lay down (laying down would have made me scream).
I'm not a sucker for pain. I hate it. I pulled my back recently and would have gladly taken an epidural for that. :p I just didn't want to expose my kid to drugs that he didn't need.. And it turned out that I didn't need them either.
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3-19-2007 @ 12:19PM
Crystal said...HI! I had an epidural, was progressing fine in labor, but when I had the epi, labor stopped and ended in a c-section. While it is a personal choice, I wish I wouldn't have had it now.
This happens very often.
Crystal
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3-19-2007 @ 12:30PM
eli said...I'm due in early April with a pretty big kid (estimated weight 7 lbs at 35 weeks). My plan is to go as long as possible without the epidural, and then take it if I feel I need to. The reasons for this are several fold -- 1) maybe an epidural would effect the baby; I don't think the results are conclusive yet. 2) I can labor underwater, or walking around, or in whatever position is most comfortable, UNTIL I get the epidural. No walking epidurals at my hospital. 3) I do want to be conscious for the birth. Depending on how exhausting the labor is, I'll have to make a decision about whether an epidural will help me rest and be more lucid, or whether it will take away too much from my experience of the birth.
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3-19-2007 @ 2:11PM
AdrienneB said...If I had to have a baby in the hospital, I'd probably opt for an epidural simply because hospitals require women to labor in ways that are needlessly painful. Many hospitals require you to be monitored the whole time lying on your back which is the absolute worst position for laboring. Hospitals also push the epi because it makes them a lot of money and they neglect to mention that there are milder forms of pain relief available that can do the trick just as well.
I had my daughter at home, free of medication. I was able to whatever I wanted to manage my labor and suffered very little discomfort as a result. BTW, don't assume that the epi is the cause of all breastfeeding problems. My daughter never learned to latch even though I had a med-free delivery.
I think what is key is learning all you can before you make your decision. Once you've done that, it's no ones' business to judge you. We women seem to waste a lot of time and mental energy doing that and it's a shame.
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3-19-2007 @ 5:25PM
Nadine said...Jen, I had complications due to my epidural -- things no had mentioned could happen. I was terrified of labour and asked for the epidural a few hours after my water broke.
The epidural paralyzed me from the waist down and I could not have walked to save my life. (This went away but it took hours after delivery. I could not walk to the NICU to see my newborn) My contractions and dilation halted, even with the introduction of induction methods like pitocin and I ended up having an emergency C-section after 14 hours in the hospital. I also spiked a fever and went into shock, shaking and shivering uncontrollably. (Not sure if that was from the epidural.)
The thing I hated most is that with the paralyzing effect, I no longer had any control of my body. All the years of yoga I had done, nullified with one scary-looking needle. If I had to do it all over again, I'd do it with a midwife or doula and epidural-free.
Good luck with whatever you decide. The important thing is the healthy baby at the end of it all. It's just good to know the potential side effects. Also, you can't get the epidural very late into labour because you have to stay extremely still for them to insert the needle into your spine without side effects. If your contractions are really bad, you won't be able to stay still for that. These are good things to know. It's not always as simple and breezy as they make it out to be.
Best of luck! I'm sending you positive vibes. Can't wait to hear how it all goes!
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3-19-2007 @ 12:56PM
LS said...I had a good experience with an epi. It was always in the birth plan as an option. Several hours into normal labor, I opted for the epi, and it helped me to settle - I had been panicking a bit with the breathing.
For me, having the epi already done turned out to be a blessing in disguise, because after 12 hours of progressing and labor, I was fully ready to deliver, but my baby hadn't moved a centimeter. Further, with every contraction, his heartbeat dropped alarmingly. My doctor decided that a c-section was necessary, and the sooner the better. With the epi already done, all the anesthesiologist had to do was up the dose a bit to make me numb for surgery. 20 minutes later, my son was born. And the c-section, it turned out, had been absolutely necessary - he was so wound up in the cord that a normal birth might have done serious damage (or killed) both him and me.
I agree with many of the posters before me - this is a completely personal decision, and one you should make based on your own beliefs, and your own tolerance for pain. Do not be pressured by "activists" on either side of the issue. Discuss it with your doctor, your spouse, and any others you trust (mom, friends). For the record, my son didn't suffer any ill effects from the birth - he was breast feeding almost immediately. The only "ill effect" I suffered was that I slept it off - I got a nice two hour nap!
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