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 (sometimes desperately)
  • 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 moms 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. The cons of epidurals are less well known:

  • Getting an epidural means lots of other medical things have to be done also. You will need IV fluids, your BP will be checked regularly, you will have continuous fetal monitoring, and you will probably have a catheter and a pulse oximeter (measures your blood oxygen levels).  You will not be able to leave the bed (although, as mentioned, you may 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 mom, which means that she may be treated with antibiotics in case of infection. Baby may also be subjected to an invasive septic work-up to rule out infection and/or will be treated with antibiotics.
  • Epidurals can affect the initial breastfeeding. I’m not sure how much stock to put into this because some epidural babies latch just fine and some medication-free babies have trouble with the initial latch (and vice versa), but studies show that there is an increased risk of initial breastfeeding difficulty in babies whose mothers had epidurals.
  • Epidurals anesthesia can make your BP suddenly drop, which is risky for mom and baby. The IV fluids are given to head off this potential complication.
  • Reactions to the medication can range from the very common 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. I’m all for it, and I could list several items that were pros for me (but I can also see why someone would not relish this particular mode of birthing):

  • Allows your body to follow the hormonal “blueprint” that helps prime you for motherhood and your baby for life outside of the womb. 
  • Increased the bond  between my sweetie and I. Being able to trust that I could “lose control” and still have him there by me, 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).
  • You don’t know how it will feel or how you will cope. You may worry if you will be able to cope.
  • You may come up against some big fears that you are not ready or able to face (this could be especially true for survivors of abuse).
  • “Losing control” or surrendering to the process can be difficult and/or terrifying 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? Whatever that happens to be is A-OK.

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.

“There is a secret in our culture and it is not that birth is painful but that women are strong.” -Linda Stavoe