To Epidural Or Not to Epidural, It's Not a Question

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Of course these posts seem to write themselves perfectly and eloquently when I am lying in bed at night, trying to go to sleep. Let me see now if I can conjure up the gist of the thoughts I had last night.

When it comes to labour, as I noted in my most recent post, it is essential for moms to be surrounded and feel supported by people who not only believe in her ability to birth a baby but also who will do and say what she needs them to in order to create HER safe birth environment. This basic element is necessary to have present in order to allow for the other coping strategies to shine in their effectiveness.

When I first started attending births, in 1998, I had a huge bag of “tricks” I brought with me each time. I carried tennis balls, massage tools, a rebozo, a rolling pin, hot/cold packs and more. This wasn’t including the change of clothes, toothbrush and deodorant I still have with me – although I usually leave them in the car. I brought the “tools” because that is what I was told I would need when I took my training to be a labour support provider.

As I attended more and more births I came to realize that the tools were handy in some, rare, cases but that most of the couples I was working with already had all we’d need. I needed, instead, to keep my calm voice, my understanding of how a woman’s body works and information about what is and is not typically normal. I needed to know my stuff but I didn’t need to have special physical skills.

It became quite apparent that couples were hiring me because of my experience and my intrinsic belief that they were capable of birthing their baby. Many of my past clients have come from the prenatal classes I have taught over the last ten years. That said, most of my clients have come back to have second and subsequent babies with me so something I did must have been right. By the end of a 6-week (or two day) prenatal class series couples know about my personality, the way I talk and how I perceive the birth process.

They also know what I think about epidurals. That is likely why 80% (+) of my past clients have birthed without medication in place. They wanted to know what their bodies could do and they knew that I had every faith in them.

Unmedicated birth isn’t always easy when there are people popping in to advise a labouring mom that “the anaesthetist is around just now and so do you want an epidural while s/he is here so that you don’t have to wait when you ask for one later?” (You would be amazed at how often this question is asked.) I have even been to one Toronto-area hospital where a client of mine was openly laughed at and mocked when, in triage, the nurse asked her when she was hoping to get the epidural. Mom replied that she hoped to avoid one. The response of this extremely unprofessional nurse was (and I quote): “Yeah. Okay. Good luck with that. It’s your first baby, isn’t it? Uh huh. Okay, well let me know when you change your mind.” (Yes, I took notes AND a name to reply to that one.)

When I teach classes I let the couples know some of the potential risks and benefits of having an epidural. These may include:

PROS
May offer pain relief
May offer mom the chance to rest
May be medically necessary
CONS
May not work the way mom wants
Mom will be unable to get up to urinate
Some moms complain of long-term back ache at the epidural site**
May slow labour
May drop mom’s blood pressure (an IV will be administered)
May increase the need for surgical interventions (i.e. vacuum, forceps, episiotomy and/or caesarean section)
Will increase the risk of tearing
May give mom a spinal headache
May affect the baby
May result in an allergic reaction to the narcotic (mom would need more medication)
Is cumulative (results in increasing physical disconnection the longer it is in place)
Limits options of positions for pushing in second stage labour

**An epidural leaves a scar on the back still visible many years after giving birth. Don’t let anyone tell you that an intrument capable of creating such a large scar isn’t also capable of causing long-term trauma to the back.

As often as not I see epidurals not offering moms the relief from discomfort during labour that they were hoping for. Usually it just changes location, moves to the hips, low back or pubic bone. Once it becomes localized like that, there isn’t anything mom can do other than have someone use counter-pressure in that spot to try to relieve some of the pain. The nerve endings are frozen from the medication and the body stops releasing the endorphins necessary to help moms cope.

It is also, usually, a fallacy that moms will get a chance to rest while they are medicated. Most moms are so wound up from labour and from the process of getting the epidural that they can’t sleep. Their partners can (and this usually furthers moms’ frustrations) but mom is rarely able to get much rest however, she has likely added considerable length to her labour so she will be more hours, overall, without adequate sleep.

Somehow movies, television and other people have managed to create this illiusion that getting an epidural is euphoric, painless, risk-less and necessary. Expectant women get the impression that they will be able to smile and file their nails (yes, I have seen this happening on more than one episode of the show on TLC in the afternoons) while they labour. It is implied that all pain and discomfort will totally vanish.

Did you know that, even with a regional block, you WILL feel considerable pressure in your bottom (often felt as pain) when the head of your baby is quite low? If you can’t feel it then something about your epidural is not the way it should be. You are supposed to feel the pressure so that you “know where to push.” (Not that you’ll be able to make that determination because there is a big void area between the top of your uterus – which you should feel – and the pelvic floor.) Many moms are not expecting the pain to come back (in any form) and are therefore taken by surprise when the pressure continues to build and they find themselves uncomfortable again. If they haven’t had a chance to rest then they have even fewer reserves to draw upon for coping.

Because of the increased risk of a mom requiring the use of a surgical intervention with her epidural she also increases the odds that the baby will need to be assessed by a respitory therapist, paediatrician or other neonatal specialist at the time of birth, decreasing the speed with which we can unite mom and baby, skin-to-skin, the way our babies require.

The potential delay in bringing baby skin-to-skin with mom after the birth has the potential to impact how soon a baby is able to breastfeed (and the mother’s feelings about being able to breastfeed) as well as resulting in the baby having higher cortisol levels (stress hormones) then their unmedicated peers.

It isn’t going to have an impact on my life what choices a labouring mom makes for herself, and by extension for her baby. I feel it needs to be said however, that it is imperative for a woman to make a truly informed decision about how she wishes to progress through the process and birth her baby. We, as a society, have made epidurals synonymous with giving birth and that creates unacceptable pressure on a labouring mom to try to “defy the medication odds.”

If a woman is going to ask for an epidural, obviously it is her choice. However, let me leave you with the thoughts of Dr. Christiane Northrup as she spoke about the use of “pain relief” in the 2008 movie, “Orgasmic Birth.” She said:

Epidurals cause you not to be able to feel your sensory nerves in your pelvis. Now think of it this way, the sensory nerves in your pelvis are the highway that your baby is traveling out on. What if you numbed your feet and then you were supposed to walk down a highway? You’d have difficulty walking down the highway. Let’s say your motor nerves work, your muscles work the motor nerves that move the feet. Without the sensory [nerves] if your feet are numb they don’t work the same way. So if your birth canal is numb [with an epidural] it doesn’t work the same [it is supposed to].

Posted by Sam