"I don't know if I can do this," I whisper it into the blurry room. The contraction begins to rise and I scream, sing, breath, and pray simultaneously. With a final push, the crescendo, her body slips through mine. I catch her and bring her to my chest, elated.
Three natural childbirths later and I have no regrets. Each time, I was afraid. Each time, the baby slid out into my arms and the pain evaporated, replaced by pure relief and indescribable joy.
Please note as you read this article that I am not against the epidural. On the contrary, I am simply FOR more education for women. I've heard too many stories from new mothers who express deep sadness about their labor & delivery experience and the repercussions of choosing an epidural. The information presented here is meant to serve as a guidebook of data and a compilation of experiences so that you can make the decision that is right for your family.
The first epidural to be used for childbirth dates back to somewhere in the 1930's and 40's. The precise date is disputed. We do know, however, that they did not gain wide popularity for pain relief in labor until the 1970's. Epidurals as a pain management option for childbirth is relatively new - less than 45 years old.
The U.S. Centers for Disease Control National Center for Health Statistics published a report about the use of epidurals in 2008. Based on data collected from 27 states that track the use of anesthesia for labor, six out of ten women with a singleton birth received an epidural or spinal anesthesia. In my own hometown of Tucson, Arizona, hospitals report epidural rates between 65-85%.
While epidurals may be a good option for some women, it would be folly to discount the risks and side effects - for both mother and baby. The needle provides temporary pain relief, but it also can lead to a slew of unwanted interventions and a slower recovery.
Consider these 10 reasons why you may want to think twice before calling for the anesthesiologist.
Because epidurals require IV fluids, bladder catheter, and full time electronic fetal monitoring, mothers are unable to be in control of the natural progression of labor. Deena Blumenfeld, a Registered Prenatal Yoga Instructor and Lamaze Certified Childbirth Educator in Pittsburgh, explains, "The epidural restricts mom to bed, and it restricts her movement. When mom's movement is restricted it can cause a number of complications, including: fetal distress, low fetal heart rate, and inability for baby to rotate to the anterior position (optimal and normal for birth)." Ultimately, she says that the "use of the epidural can be a direct cause of c-section."
It is not uncommon for epidurals to increase the mother’s body temperature. A recent study pinpointed that over 19% of women who received an epidural experienced a fever of 100.4 or higher. Fevers, in turn, can increase both the mother's and baby's heart rate. Since fetal heart rate can be a sign of distress, doctors often react with the suggestion of a C-section. Even if a C-section is not the outcome, the heightened heart rate often leads to further investigations of the baby after birth (which can include blood and spinal fluid samples). This can lead to days of separation, observation, and possibly antibiotics - which inhibits mother-baby bonding and the establishment of a strong breastfeeding relationship. Kelly Whitehead, author of High-Risk Pregnancy: Why Me?, had this very experience. After a spiking fever, she had to leave her baby behind at the hospital for a few days after her discharge as a preventative measure. She commented, "It was extremely hard emotionally to leave my daughter behind. Breastfeeding her kicked off with a rough start since I was separated from her moments after birth. Though the hospital lent me a pump, I found that difficult, especially being a first time mom."
A sudden drop in blood pressure is one of the most common side effects - which is why blood pressure is taken every 5 minutes when the epidural is initialized and every 30 minutes thereafter. A drop in the mother's blood pressure affects how much of her blood is pumped to the placenta and can lead to less oxygen being available to the baby.
Many women with epidurals report having persistent and/or chronic headaches post-delivery. Blumenfield says that this happens when the epidural needle is inserted too far, "...it can release spinal fluid up to the brain, causing a spinal headache. These are severe and often debilitating, lasting for hours or days."
Epidurals often slow the second stage (or pushing stage) of labor by interfering with the natural hormone of labor (called oxytocin), as well as reducing moms’ ability to push effectively. Since the mother is numb, she is unable to get in the most helpful positions to help guide the baby's descent.
The gold standard of medical reviews, a Cochrane Review, came out with this research in 2011. Epidural babies were more likely to be delivered with the "help" of forceps, a vacuum, or other tools that increase pain and discomfort for both mom and baby (Cochrane Database of Systematic Reviews 2011, Issue 12. Art. No.: CD000331. DOI: 10.1002/14651858.CD000331.pub3). The use of instruments also increases the likelihood of a woman having a more serious tear and/or receiving an episiotomy.
Nick Angelis, a nurse anesthetist and the author of How to Succeed in Anesthesia School, states this matter-of-factly, "statistically, the chance of getting a c-section increases with each medical intervention [including epidural]." He also points out that mothers seeking a natural childbirth experience would be wise to avoid labor augmentation drugs such as Pitocin since it is known to make contractions less manageable for the new mother.
Elizabeth Chabner Thompson, MD, is a New York mom of four. A graduate of John Hopkins Medical School, she initially did an OB/GYN internship, but ended up changing specialties to focus on oncology. Two of her babies were delivered with an epidural, two without. She far preferred her non-medicated births, "A woman delivering without anesthesia recovers much faster than with anesthesia. I tore much less -- I could feel everything so I was able to pay attention to my pushing." She even went on to say that she, "was up and running behind the stroller within a week after delivering without anesthesia...it was much easier to care for my other children." Though perhaps not all new mothers will be jogging at one week postpartum, there is certainly something to be said for being able to get up and around quickly.
Studies have shown a link between epidurals and breastfeeding rates among new mothers. Whitehead explains that this is "due to neurobehavioral effects in the baby in regards to initial rooting and suckling behaviors." Note that epidurals also interfere with the natural production of oxytocin (as stated above)...the hormone which causes the let-down effect in breastfeeding and promotes healthy bonding between mamas and their babies.
Women have reported nausea, itching, backache, and incontinence. Little is known how the epidural effects the baby, but we do know that the drug does enter the baby's bloodstream. It seems contradictory that many women take great precautions to avoid deli meat, coffee, wine, and tylenol throughout their pregnancies...and then proceed to take in a heavy anesthetic agent right before meeting their babies for the first time.
Scientist Kelly Whitehead correctly points out that "There is a time and a place when epidurals are needed and necessary, such as for C-sections, moms who are having very long, hard labors or those moms who are truly not managing well during labor." She notes, however, that pain, crying, and yelling don't necessarily mean that the mother isn't managing well. Those can all be "normal" during the laboring process.
Kimberly Jacobsen Nelson, a freelance reporter from Oregon, has had three babies - the first with an epidural, the second two without. She describes the epidural as a "massive mistake" and wishes she had been better informed about the risks. In contrast, she says her two natural births were "the most amazing thing I have ever done...so rewarding. [My labors] were fast - 4 to 6 hours - and the babies came out so much more alert."
Elizabeth Greenwell, a doctoral candidate at Harvard School of Public Health, completed a study about epidural use and fevers which involved more than 3,200 women delivering a full-term baby at Brigham and Women's Hospital in Boston in 2000. She concluded, "It's clear that from our data that about 20 percent of the term infants born to mothers who received epidurals experienced one or more adverse outcomes after birth." Twenty percent is certainly enough to give a new mother pause before requesting drugs.
Share your experience! What would you change about your labor & deliveries (if anything)? Did you experience any side effects related to using the epidural?