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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 3 of 3)
3-20-2007 @ 8:27AM
Brenda said...I am really sick of the myth that childbirth is the most painful experience you could every experience for EVERY woman. While I am sure it is painful for some or even most women it is not painful for all. It wasn't painful for me and I was in labour for three days because my baby just wouldn't get into a good position.
My grandmother gave birth to four during the age of knock 'em out but for her last baby anesthesiologist couldn't be found and she gave birth unexpectedly without any drugs he exact quote "What's the big deal, you have a baby".
Labour IS more painful when you are afraid. If you kick in your flight or fight repsonse which many women experience in hospitals it deprives your uterus of oxygen. And as anyone who exercises knows it is when your muscles stop getting adequate oxygen that you "feel the burn".
I am sure for some women the pain is so intense that not having some painkiller is not an option, but I wonder for those women if it is a combination of expecting it to be painful and some other factor.
None-the-less I am sick of being treated like a nut job who is lying when I say that labour isn't painful.
The article you have referenced fails to mention most of the more serious side effects. For one thing epidurals can and do stall labour which leads to other interventions. Epidurals cause your temperature to rise, if it rises high enough you and your baby will be getting IV antibiotics "JIC" and if the doctor is concerned enough you will be asked to consent to a spinal tap on your newborn.
And epidural will most likely at least temporarily lower your blood pressure, which will temporarily reduce the amount of oxygen getting to the baby. For most babies this can be tolerated. Most but not all.
More from:
http://www.childbirthsolutions.com/articles/birth/epidural/index.php
Undesired effects on the mother:
Inadequate pain relief (up to 10%)4
Rise of the mother's oral and vaginal temperature 5, beginning within one hour after administration of the epidural, which may lead to treatment of the mother and baby for non-existent infection. This effect may be dose-related. This recent finding from England is being investigated in the United States.6
Drop in the mother's blood pressure treated with position changes, oxygen and possible vasopressors (less likely if a bolus of IV fluids is given before the epidural).
Short or long-term postpartum backache from bruising caused by the injection or from ligament strain caused by prolonged time spent in a damaging position or inappropriate movement (for example, extreme passive flexion of the mother's trunk, hips and knees during the second stage, or sudden vigorous movements of the mother) while her muscles are relaxed and her back is numb (up to 19%). Long-term backache is almost twice as likely to occur with an epidural than without.7
Possible unintentional spinal block and resulting spinal headache requiring days of bed rest and a blood patch.
Shivering may be reduced with lower doses, by warming of the anesthetic before administration, or by adding narcotics to the anesthetic.8
Mild to severe itching of the skin (with narcotics)
Retention of urine, requiring a bladder catheter1
Mother feels detached from the process and becomes an observer; others may reduce emotional support. The nurse can no longer assess labor progress by observing the mother and must rely more on the monitor and vaginal exams.9
Problems caused by human error or maternal structural anomaly, such as inability to place catheter properly; inadvertent injection of anesthetic into a blood vessel; or too much anesthesia, affecting respiration and swallowing (rates vary with skill of the practitioner and anatomy of the mother).
Rare complications, such as residual numbness or weakness from needle injury to nerves (almost 1 in 10,000)10, delayed respiratory depression with epidural narcotics (up to 12 hours later)8, and brain damage and death (extremely rare)11.
Undesired effects on the labor:
May slow labor, requiring Pitocin; and has been found to increase the chances of a cesarean delivery in primigravidas by two or three times.12
Often slows second stage by reducing or eliminating the normal surge of oxytocin; and by reducing pelvic floor muscle tone, which may lead to more deep transverse arrests or persistent occiput posteriors. In addition, forceps or vacuum extractor are required more often (20-75%). Delaying pushing until the fetal head is on the perineum reduces the need for forceps. Even though this approach lengthens the second stage, it does not increase the incidence of fetal distress.13
Undesired effects on the fetus:
Abnormal heart rate patterns, requiring oxygen to the mother, position changes and possible cesarean delivery.
Increased likelihood of newborn septic workup, IV antibiotics and isolation in the nursery if the mother develops an "epidural fever" that causes fetal tachycardia or newborn fever.
If the fetus is already stressed greater amounts of the medication are "trapped" in the fetal circulation, leading to more pronounced newborn effects (see below).
Undesired effects on the newborn:
Short-term (six weeks or less) subtle neurobehavioral effects, such as irritability and inconsolability and decreased ability to track an object visually or to shut out noise, bright light.4 There are no data on potential long-term effects.
Possible less efficient or less organized initial rooting and suckling behavior. Nurses have reported more difficulties in feeding babies whose mothers had an epidural when compared to unmedicated babies.6
Decreased infant responsiveness may lead to long-term consequences for the parent-infant relationship.14 Parents should be counseled to give their babies time to recover from the birth and medication and should avoid a label of "difficult child" or "incompetent mother."
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3-20-2007 @ 10:08AM
Anonymous said...Jeez, when will this stop!!! "I could totally handle the pain. You can too. Stop being such a wuss."
UGGH. Talk about your macho posturing.
Get back to me in 18 years and we'll compare kids.
Epidurals are statistically just as safe as not having them. This is not the same medical/financial/misogynist conspiracy as the turn of the century when male doctors and their unwashed hands took childbirthing away from the midwifes. OB/GYNs actually study this stuff for many years and care deeply about the safety of both mothers and babies.
Also, this nonsense about "detachment from the process" of childbirth. What a load of hokum. I had an epidural and I was as present as the day was LONG. And as I said before - nursing was no problem.
Again, mind your own business. As those of us who already have children know, birthing is only one moment in your life with your child. That's why they tell you to not get too attached to your birthing plan. Anything can happen and at the end of the day, the baby is more important than the story you tell about birth.
Those of us who have had epidurals in hospitals can also go through a litany of anecdotal evidence about the horrors of not having an epidural.
There will always be stories of women who hardly felt their contractions and practically gave birth on the way to the birthing center/hospital/bathroom what have you. Everyone hopes that they'll be the pain free birthing types and most of us are not.
Pain is one of the few things in life that simply can't be shared. So mind your own business if you like feeling it.
We all care abour our impending children just as much whether we decide to mitigate our pain with the epidural or not.
And this crap about not having any idea about the effects of the epidural on babies? They weren't invented yesterday. We have YEARS of babies growing up just fine - breast and bottle fed - who were born of epidurals.
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3-20-2007 @ 10:25AM
Miss said...Anonymous...I don't know that I agree that babies are "growing up just fine." It seems there are many studies, as well as a load of anecdotal evidence, to suggest that they just don't make 'em like they used to.
As for your demand of silence from those who encourage women that their bodies can give birth on their own - I could flip it and say "mind your own business" if you want to spout how terribly painful your birth was.
The fact is that we are each just sharing our own experiences and stories.
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3-20-2007 @ 10:51AM
anonny said...I don't hear a whole lot of "sharing stories and experiences," Miss. There is a lot of pressure on women NOT to have epidurals. And that pressure primarily comes from other women who seem to think that there is a right way and a wrong way to deliver a baby.
The "they just don't make 'em like they used to" argument does not hold any water if you're trying to tell me that the epidural has anything to do with it.
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3-20-2007 @ 12:47PM
SKL said...Anonymous,
I don't see why you are getting so upset that some of the posters are pointing out (a) possible complications of epidurals and (b) encouragement for mothers who may be willing to try natural childbirth.
It is a fact that childbirth is not always painful. Why does that upset you?
You are entitled to your opinions and feelings, but these posts are not an attack on anyone, other than people who would prefer for all women to be uninformed and afraid of their own natural processes.
Nobody has yet passed judgment on someone who has had an epidural. Mostly we are saying that we would not choose it for ourselves and why. This is a reaction to the blogger's original comments implying that the risks are myths - a misleading comment that deserves to be rebutted.
If you have "facts" to add to the discussion, feel free to add them, but don't expect others to shush just because their comments don't reflect your view of things.
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3-20-2007 @ 10:28PM
Sheridan said...There are other options for comfort during birth other than drugs. I used Hypnobabies www.hypnobabies.com for my last birth, it is childbirth course that includes real medical anesthesia hypnosis, the same type that people who are allergic to medications use for dentist. Here is my story with using it and lots of other moms birth stories too. http://www.pregnancybirthandbabies.com/hypnosis_and_childbirth.htm
You can see my birth video here http://www.youtube.com/watch?v=OA7Y_DnC_kA
Hope this gives you another idea.
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3-21-2007 @ 3:59PM
P_lopez said...I didn't have an epidural but my sister and sister-in-law did and now they suffer from chronic back pain. I was a week past my due date with my first and when I went into the hospital for a check up was not efaced, or anywhere near dialated. The whole process took about 40 hours to finally deliver my baby but after about 12 hours I opted for demoral to be able to rest. I had two "hits" this before I had to push. I didn't notice a difference at first. I did however have trouble with breastfeeding my baby and his latching onto the breast. After reading some things on the internet I quickly realized that the after effects of the drugs played a role in this issue. Babies are affected by the drugs and from what I read, this can cause problems with lacthing on because they are numb. Just try to imagine how the drugs affect an adult and compare that to a little baby. Normally, it takes about 2 weeks for the affects of the drug to wear off completely and that is just about how long I struggled with breastfeeding almost 3 weeks. I do beleive that this is a personal choice and I respect that. However, with my next pregnancy I am going to take this into consideration. I'm not saying I wont't use any drugs such as demoral (definitely not an epidural unless I need a C-section) but I will try to suck it up just a little bit more!
I wish you the best in your decision and don't let anyone try to force anything you don't want to do.
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3-23-2007 @ 5:01PM
Megan said...It is a very personal decision and although I did not want medical intervention my very long and very hard labor with no progress made it almost unbearable. We had to use PIT with my first and then ultimatly ended up with a c section. My second was breech and a planned c section my third was really big and really late so I was induced. After hours of really hard labor and no progress I tearfully decided to get a epidural. Now I wish I had tried to stick it out longer-- All my babies were fine but very tired and I was very tired too! And you have to have a cath. so you also have to get all those things straightened back out too!
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3-23-2007 @ 6:13PM
debbietrout4 said...I would never reccommend having a epidermal to anyone! 13 years ago they gave my daughter one and killed her instantly in the birthing room! I have a handicapped grand-daughter that has cerebal palsy because of it and only one daughter now.
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