To have an epidural or to not...that is the question!

by Justine Waldram


For some it is any easy choice, either for or against getting an epidural as a means of pain relief during labor and birth. For others it is not so easy. Some women choose to wait and see how the labor goes and they decide in the moment whether or not they need the epidural. Others spend some time researching the pros and cons and make a decision and plan before labor and birth start. 

There is no RIGHT or WRONG way to do it. Everyone has their own reasons for the kind of pain relief they seek during labor and birth. I do feel like its so important to know what the options of pain relief are and what the costs and benefits of each are as well. 

An epidural is widely known as the best method of pain relief during labor and birth. Nearly 60% of women use one for their birth. Have you ever wondered--what is an epidural? Well, just incase, it is an anesthesia placed in the epidural space, right next to your spinal cord. The epidural space is about 4mm wide ___ about the size of that line I just typed... and thats where the needle and medication need to be placed. After the needle is in the right place a small catheter replaces the needle. This only takes about 10 minutes. Once you have an epidural you'll most likely have a bladder catheter, a blood pressure cuff and continuous fetal monitoring. Although there are such things as "walking epidurals", they aren't super common so you'll most likely be confined to you bed for numerous hours once the epidural is in. 

Woah. Lots of info. 

Ok, so why do women want epidurals. Lets name the reasons: Typically provides complete pain relief. When it works, it works well. You can sleep and relax through labor. It can allow a tense woman to relax and her labor to move along. 

Thats all pretty straight forward I think. Sounds pretty good right?

Ok. So then why not? Some women don't want them because: For some it doesn't work well or at all. Side effects can be serious and possibly long lasting. They want to be able to move during their labor and birth. They don't want to lay in bed. It makes them feel trapped/stuck. They don't want the baby to get the drugs. Other interventions are more likely.

OK. Not so straight forward. May need a few facts to back that info up right...? Here:

Epidural fail rate is 12% (6). Often the anesthesiologist can fix the problem but not always.

Possible side effects: for you- Anxiety, nausea, vomiting, chills, fever (2), fluid overload from IV, increased vaginal tearing, temporary urinary incontinence, nerve injury, muscle weakness, dangerous drop in blood pressure, long term back problems (7), spinal headache (7), seizures, heart attack or respiratory distress. For baby- drops in heart rate (distress), low oxygen to baby, injury from forceps or vacuum, low muscle tone (limp when born), more likely to need NICU stay. 

Statistically epidurals do increase the chances of a cesarean (3). Babies are less likely able to do their normal rotation down the birth canal (1). Babies are more likely to be stressed out--their heart rates drop (4/5)--leading to emergency surgery. 

From the manufacturer's packaging of bupivacaine, the most common epidural drug: "Local anesthetics rapidly cross the placenta and...can cause varying degrees of maternal, fetal, and neonatal toxicity...Adverse reactions in the parturient [woman], fetus, and neonate involve alterations of the nervous system [brain damage], peripheral vascular tone [blood vessel damage], and cardiac function." 

Other interventions such as a need for pitocin (1), episiotomy--being cut from vagina to anus (yup I said anus)--or forceps or vacuum extraction (3). 

Movement in labor is a key component to helping the baby move down, rotate and dilate the cervix the way it is all meant to happen. 

The choice is yours or course. Epidural or not, home birth, hospital birth, circumcise, vaccinate... these are all choices we get to make. I know so many women that love using epidurals for their birth and I support them in their choice! For some women, it is what they need to have the birth they want. The purpose of this blog is to help women know more about the choices they make. I want all women to have good and memorable birth experiences. Thanks for reading :)

 

 

(1) Howell, CJ (2000)     (2) Lieberman, E. et al. (1997)    (3) Thorp, JA and Breedlove, G. (1996)   (4) Ramin, SM et al. (1995)  (5) Thorp, JA et al (1993)       (6) Pan, PH et al. (2004)   (7) MacArthur, C. Lewis, M., and Knox, EG. (1992)