Epidural: Friend or Foe?
Well, I asked for suggestions for a new blog entry and someone helpfully suggested one of the most controversial topics in maternity care: THE EPIDURAL. Is this too much for one blog entry?
I guess we’ll find out because I’m going to take it on. But don’t expect me to come down on one side or the other. I’ve never seen this stuff as black and white and I don’t support arguing over it.
What I do support is knowing what you’re getting into (as much as possible considering we’re talking about labor here, the essence of unpredictable), whether we’re talking about getting an epidural or “going natural.”
So let’s break it down.
Pros of an epidural:
Takes the pain away, but leaves you mentally still “with it”
Allows you to rest if needed
Relatively little medication gets to the baby
The amount of medication can be adjusted so that you can have some sensation and motor control in order to push and change positions (while remaining in the bed, of course). I have been able to help some laboring people maneuver into a squatting position (with a squat bar) or onto hands and knees all while under the effects of epidural anesthesia.
Most of those pros are common knowledge. Some of the Cons of an Epidural are less well known:
Getting an epidural means lots of other medical things come into play. You will need IV fluids, your blood pressure (BP) will be checked regularly, you will have continuous fetal monitoring, and you will probably have a urinary catheter, and a pulse oximeter (measures your blood oxygen levels). You will not be able to leave the bed although you will be able to change positions in the bed.
Sometimes an epidural doesn’t work. Or it only works on one side (if you don’t believe me, just Google “epidural only worked on one side” and you’ll come up with hundreds of thousands of hits). Or it leaves a “hot spot” where you can still feel pain.
An epidural can slow down your labor. (note: sometimes it can also speed up labor and sometimes labor stays at a steady pace). If your labor slows, you will likely receive Pitocin augmentation and it may be increased more quickly because providers are not as concerned about your pain since you are receiving pain medication.
Epidurals can cause fever in the birthing person, which means that they may be treated with antibiotics in case of infection. The baby may also be subjected to an invasive septic work-up to rule out infection and/or will be treated with antibiotics.
Epidurals may affect the initial breastfeeding. I’m not sure how much stock to put into this because some babies that were exposed to epidurals latch just fine and some medication-free babies have trouble with the initial latch (and vice versa), but some studies show an increased risk of initial breastfeeding difficulty in babies whose mothers had epidurals.
Epidurals anesthesia can make your BP suddenly drop, which can be risky for the birthing person and the baby. The IV fluids are given to head off this potential complication and there are also medications that can be given to bring blood pressure back up if it does drop too low.
Reactions to the medication can range from the very common, like itchiness (usually starting at the chest and neck), to the much rarer severe allergic reaction to the anesthesia.
These actually aren’t all the cons, but I think you get the picture. Getting an epidural isn’t always easy and breezy, although for many women it is.
And you know what else is not always (or even often) easy and breezy? Yeah, you guessed it; unmedicated childbirth. There are many pros and cons to this mode of birthing as well. Here were some of the things that I saw as pros when I was birthing:
Allowed my body to follow the hormonal “blueprint” of labor that helps prime it for the parenting role and prime the baby for life outside of the womb.
Increased the bond between my partner and I. Being able to trust that I could “lose control” and still have him there supporting me, was an immeasurable feeling and made me fall in love with him all over again.
Made me feel incredibly powerful. It’s incredibly powerful just to carry and grow a baby inside your body. Giving birth can intensify that feeling.
It was like a rite of passage. I came up against some big fears and I had to face them in order to move forward in labor. Though it was hard, it was also rewarding.
But the cons are many as well:
It hurts (for many or most women and birthing people), or at the very least is quite intense.
You don’t know how it will feel or how you will cope. You may worry about whether you will be able to cope.
You may come up against some big fears that you are not ready or able to face.
“Losing control” or surrendering to the process can be difficult, scary or unpalatable to do.
You may cope well at first, but if labor is long, it can severely deplete your ability to handle the rest of labor.
In the end though, it comes down to this: What are your needs? What can you do to help you meet those needs? There is no right way to give birth. As long as you are responding more to your own wishes than someone else’s idea of what is good or right, you’ll be on the right track.
One big piece of advice, though: Make sure you are not making decisions based on fear. Fear is fine and normal, but it is not your friend when making big decisions. Take these steps during your pregnancy:
Think about your fears. Are you terrified of tearing during birth? Are you scared of how you will act in labor and what people around you will think? Are you scared about being a parent?
Talk with someone you can trust about these fears (your partner, your childbirth educator, your doula, your friend, your counselor) or write them down. Often there actions you can take that will address your fears. Sometimes even, just getting them out can make you realize that maybe it’s nothing much to worry about after all.
Having your fears addressed and your priorities in order will help you proudly chose how you want to birth. And it will help you make choices during labor, too, if (when) unexpected things pop up.
Many blessings for your birth.
