I’ve been asked recently to clarify my stance on epidural use during childbirth. It is not the first time I have been asked about this and I know it also will not be my last. Most recently, it was following a “status update” that I wrote on my personal facebook page after learning the epidural rate in my area is 97%! While it knew it was high, I was absolutely shocked to learn just how many women have an epidural for birth. Before I start, I want to state one thing…I am not anti-epidural and I do not judge women for choosing to use one during their labor. It may not sound that way once I discuss the risks and benefits of the procedure, but I absolutely support a woman’s choice to do what she deems correct for herself and her baby during labor. Every labor and birth is unique and only the laboring mother and her baby can truly appreciate the experience. However, it is not the right choice for me and I will explain why. My issue is not really with epidural use, moreso the conditions of our society and the medical practices surrounding their use.

If you know me, have followed my blog or listened to me babble about my birth story, you will know that when I initially conceived I had full intentions of getting an epidural. In fact, at that time, I felt that if they could give me the epidural BEFORE contractions began, I would be the first standing in line. Then I saw Ricki Lake’s documentary, “The Business of Being Born” and I realized that birth is not meant to be a medical event; it’s not meant to be feared and it’s simply a natural process and a rite of passage for all childbearing women. So, even though I was scared and doubtful, I decided to take childbirth education classes. How that concept escaped me initially…well, I would say who knows? But, I do know. I have been socialized to think that way and to fear pain and to fear the unknown. I have been made by the media to think I am somehow incapable or lacking and that my body would fail me when I needed it the most.

I decided I needed to learn more about childbirth, so I chose to take a childbirth education class. I chose, “The Bradley Method of Natural Childbirth,” because it made sense to me. It is based on relaxation, a partner assisting you during your labor and on natural, abdominal breathing.  It is an incredibly thorough education. After taking that class, I felt I knew more about my body and about labor and birth than I would ever want to know. Yet, I had my doubts about my ability to birth, to withstand pain and even during my labor…if you have read my previous posts, you will know that I asked for an epidural simply because I got scared. I was focusing on what might be to come, how much worse it could get and how much longer it could possibly take. And, since I was in the hospital, I knew that the option of pharmaceutical pain relief was there. Luckily, my body and my son had different plans, and he was born about 30 minutes after I requested the epidural and before I could actually get it. Looking back on it, what was most interesting is at that moment when I requested the epidural and felt, “There is an end in sight to this pain,” I let go and I completely surrendered to my labor. Minutes later, my body was pushing and it was no longer about pain. It just was. I felt like I had no say in what my body did. I felt completely natural, purposeful and whole. It was just happening. The feeling of my body spontaneously bearing down as I lay there on my side was absolutely incredible. I could feel my baby’s head moving down, then slightly back up, then down some more. It was the most incredible sensation and I will never forget it. Nobody told me how to push or when. I didn’t have to lie on my back like a dead beetle with my feet up in stirrups (well, not until the OB walked in as the baby’s head was coming out). My body knew what to do and just did it. I remember that one of my first thoughts as I lay there with my new baby on my chest was, “I am so glad to have given birth to my son instead of being delivered of him.” I am constantly thinking back to my birth and I feel so grateful that I had the opportunity to FEEL every bit of my labor. Honestly, labor was not a big deal for me. It was very manageable with good support and with the training I had.  What pain I felt was pain with a purpose. When it started to get overwhelming, it was basically over. I am so grateful that I was completely unmedicated because the experience of pushing my son out of my body was truly awesome. There are no words to describe what that felt like for me. I do remember thinking, “If I can do this, I can do anything. My body came through for me. I am not broken.” Never have I felt so powerful and I continue to hold onto that power in everything that I do. It has inspired me and changed my life.

But, I digress, this is not all about my one experience…it is about my feelings in regards to epidurals. Epidurals carry a host of side effects to mother and to baby—known and unknown. According to Americanpregnancy.org, “Epidural medications fall into a class of drugs called local anesthetics, such as bupivacaine, chloroprocaine, or lidocaine. They are often delivered in combination with opioids or narcotics, such as fentanyl and sufentanil, to decrease the required dose of local anesthetic. This way pain relief is achieved with minimal effects. These medications may be used in combination with epinephrine, fentanyl, morphine, or clonidine to prolong the epidural’s effect or stabilize the mother’s blood pressure.” Hmmm…bupivaCAINE, chlorproCAINE, lidoCAINE…does that look at all familiar to the name of a popular street drug?…you guess it…coCAINE! If they look familiar, it is because they fall into the same class of drug. The only difference is that the pharmaceutical varieties are legal with a prescription. What bothers me about this is that we are told throughout our entire pregnancy not to take anything more than Tylenol. We are to abstain from alcohol, cigarette smoking and basically anything that is somehow not considered to be pure that may affect our unborn baby. However, on the day where our baby is expected to do the hardest work of his life so far, we somehow think that putting a chemical into our bodies and thus into the body of our unborn baby is safe. To make matters worse, the dosages of these drugs are based on maternal weight. How can the dosage of a drug intended for a 150 pound woman be truly safe for an 8 pound infant? It doesn’t really even make sense, logistically.

 

Hmm…but, my doctor/nurse said, “The epidural does not reach my baby.” WRONG. I was under this assumption as well, but it is simply not true. In fact, the American Academy of Pediatrics published a statement several years ago which more or less read, “All drugs must be assumed to cross the placenta and no drug can ever truly be considered safe for an unborn fetus.” Yes, I am paraphrasing, but I can get the direct quote and the source of that information should anyone actually be interested in it. I am just too lazy to get off my butt right now and I don’t want to disturb my thought train. Wootwoot! <---That was a train whistle blowing, in case you were wondering. Other studies have shown that when blood was tested from a baby’s scalp just minutes after an epidural was administered to a laboring mother, the drug was found in the baby’s bloodstream.

Epidurals have a host of other side effects…like just about any medical procedure or intervention they carry the obvious, but super rare side effects such as maternal and fetal death, maternal fever, serious drop in blood pressure, seizures, infection, paralysis, spinal headache, backache, etc. Your anesthesiologist or hospital may have you sign a consent form when you pre-register or even upon admission to the hospital when you are in labor saying you agree not to sue the hospital in case you are one of the very unlucky few to experience one of these horrific side effects. Or, they may just come in and verbally tell you, “I am required to tell you that my epidural carries these risks…death, infection, paralysis…yada yada yada.” However, if you have your heart set on pain relief and are in very active labor or transition, you don’t even hear the doctor…all you are thinking about is the sooner he puts the thing in your back, the sooner the pain will stop. But, will it? Not always.

 

Oh yes, epidurals do not always work. Or sometimes they only work on one side of the body. That can be a bummer for a mom who is expecting good pain relief only to find, she is now stuck lying in bed with several monitors, a blood pressure cuff and a urinary catheter and she is still experiencing the same level of pain. Sometimes epidurals will work too well and labor becomes unproductive or stops altogether. Then your labor will need to be augmented with a synthetic (bovine-derived) oxytocin called “pitocin.” Pitocin creates stronger, longer contractions and unlike your body’s natural contractions, it is not nearly as well-regulated and the experience of a pitocin-augmented labor for the mother can be quite a bit more uncomfortable. Worse, however, is that the effect on the baby can be detrimental as well. The stronger, longer contractions can stress a baby to a point where suddenly he is experiencing “non-reassuring heart tones, decels or bad variables.” Those terms all mean the same thing, but it depends on your care-staff’s preference as to which scary word they pick. Basically, what that means is he is not getting as much oxygen as he should, and his heart rate is not reacting well to your contractions. It may be dipping down and slowly rising back up. Now they must supplement you with oxygen or have you roll on your side.  They may  back off the pitocin for a bit, but now if the baby does not recover or if you’ve been laboring “too long,” the word “C-Section” is on the table. In fact, mothers who receive an epidural are 2-3 times more likely to have a C-section. This common cascade of intervention is very common in hospitals…unfortunately; too common as our national C-section average is well above 30%. In our area hospitals, 40% is about average and further south in the Miami-Dade area, hospital C-section rates are as high as 75%.

If you do have a vaginal delivery with an epidural as many women do, most likely you will have a more difficult, longer pushing stage. You will not be able to get into a position that allows you to use gravity to your advantage. Standing, walking, squatting and hands and knees are pretty much out of the question…unless you have a super helpful and brave hospital staff (but, they are usually more concerned about the idea that you could fall and they would get sued). So, you will probably give birth relatively flat on your back in the lithotomy position with your legs either held or pulled back or up in stirrups. Most women with an epidural cannot feel their contractions or their own urge to push. Therefore, they need coaching to be told when to push, how to push and how long to push. However, because they are numb, the stress of pushing without the ability to feel their own tissues stretching and accommodating a descending baby’s head, puts them at an increased risk for tears and/or an episiotomy…sometimes both! Vacuum and forceps-assisted deliveries are more common with the use of epidurals as well.  Sometimes, women get lucky and either their epidural is weak or it is turned off in time for the pushing stage, so that they may have enough sensation to push effectively.

Epidurals have also been implicated in some other areas of concern as well—babies tend to have lower apgar scores (scores assessing the infant’s color, breathing, cry, reflexes, and tone, etc. given to newborns immediately after birth and then again, 5-10 minutes afterward). They tend to have less hand-to-mouth movements and may have more difficulty and less interest in breastfeeding. Maternal oxytocin levels are also decreased with the use of an epidural and may affect bonding and breastmilk supply.  These are just the effects that we are aware of and which have been studied. What worries me more is what we do not yet know. Afterall, x-rays were once assumed to be safe for pregnancy. Certain drugs were assumed safe for pregnant mothers until babies were born without limbs or adult children of mothers who took these drugs were infertile. The point is…we just don’t know!  Recent studies have come out noting a greater likelihood of children being autistic if their mothers were given pitocin during childbirth! Knowing how pitocin and epidurals tend to go hand-in-hand (not always, but in many cases), this is pretty startling information.

 

I think what frightens me more than anything, more than any of this medical stuff and all of the “what if’s” is what is happening to the culture of birth in our society. Women have been having babies for centuries upon centuries—long before obstetricians, long before hospitals, long before electronic fetal monitoring and long before epidurals. Obviously, they were doing something right or our species would not have managed to exist.  I mean, take any laboring woman and stick her in a room and I can pretty much guarantee you, she is going to have her baby at some point—on her own. It will just happen. Birth is a natural process. Nobody stays pregnant forever. The sad thing is our society has women convinced that they cannot give birth on their own—they need help to do it properly and safely. They thought and taught that they are also not equipped to handle “the most intense pain” of their lives. We are trained through the media or simply though social interaction to compare every pain to labor. “Well, it wasn’t as bad as giving birth.”

But, if we have the technology to take the pain away, why not use it? Why would we want to experience the pain? I asked the very same questions when I was pregnant as I have previously stated and I am not ashamed to admit that at first I was all about a “pain-free” birth. I don’t like pain. Nobody does. In the beginning, the only reason I decided to pursue other alternatives to a medicated birth was because I wanted what was best for my baby. I did not want him born drugged.  But, then I realized there is a lot more to the birth process than just “getting through the pain and pushing my baby out.” There are many ways to cope with the “pain” of childbirth. The first is completely mental…find a different point of reference for that word, “pain.” Start thinking of it as “sensation” or maybe even “discomfort.” Our minds are our most powerful opiate. 

Learn how to truly relax.  Relaxation is the key to birth. Birth is just as natural, but a heck of a lot prettier and romantic than having a bowel movement. Have you ever been in the middle of a really good you-know-what and somebody burst into the room or something scared or distracted you? What happens? You tense up and it goes right back up, right? Same thing happens with birth. Your muscles need to be fully relaxed and free from tension. The only way to fully relax is to be unafraid. Fear creates tension and tension creates pain. How do you become unafraid? You become INFORMED. You enroll in a good childbirth education series—not just the one your hospital offers you (those generally teach you about hospital policy and how to become a good patient). Take a Bradley series or a hypnobirthing series, or maybe even a really good Lamaze class. If classes don’t feel right to you, then try a self-study program. But, don’t just wait around and try to wing it. Other mammals see birth on a regular basis. They do not fear birth because they are not strangers to it and because they rely on their own nature-given instincts.  We are not that lucky. We do not experience birth regularly and usually when we do, we only experience what the media or our friends and families have to share with us. So, do yourself a favor and prepare! Some fear and uncertainty is normal for most people. It’s new. You probably would be feeling some fear and uncertainty when skydiving for the first time too…no matter how many classes you might have taken and how many times someone told you how to work your parachute. It’s normal and it’s natural, but do what you can to combat that fear ahead of time and learn everything you can!

Surround yourself with informed, caring, supportive people. If you want an unmedicated birth, commit to it. Learn about your options, understand the benefits and risks of interventions, and write a birth plan.  Consider hiring a doula…I am not just saying that because I am a doula either. Doulas are like walking encyclopedias of non-medical information during your pregnancy. They will provide you with good evidence-based resources both during your pregnancy and postpartum periods. They will offer you emotional support and they will encourage you to have the birth you desire.  They remain objective, calm and comforting during your labor when your partner or family may not. They are able to assist you with relaxation, with staying in the moment and with keeping you focused on the task at hand. A good doula will support you in any informed choice you make and will continue to remind you of your options when necessary.

All of this said, I absolutely do believe that there are circumstances where an epidural may be necessary or even helpful for some women. For example, women who are victims of sexual assault—for some of these women they simply may not be able to relax enough emotionally or physically to give birth due to the complex psychological relationship between birthing and sexuality. They may fear the “violation” of exams or of their tissues tearing during birth and may not be able to fathom a birth where they can feel anything going on “down there.” As someone who is a survivor of not one, but a few sexual assault scenarios, I would have an actual panic attack over a pap smear and I did not have one for several years because I simply could not bare the thought of lying on my back with my feet in stirrups while I was being “violated.”  I did eventually have a pap smear when my desire to change overpowered my fear—my desire to have a child necessitated a pap smear and so with the help of a lot of prescribed xanax, I got through it.

I also do not feel that a woman who is delivering a stillborn child should necessarily have to experience all of the sensations of labor unless she chooses to do so.  For some women, they feel that laboring even in this tragic situation is the only chance they have to “experience or feel” their child, but the way in which a woman chooses to birth and to grieve are extremely personal and should be respected regardless of her choice.

Then there are situations where a woman has labored for a very long time and she is exhausted. Or there are situations where maybe there is some kind of an emotional block that is not allowing a woman to relax and dilate. In cases such as these, especially in a hospital, a woman who is “failing to progress” for whatever reason, is suddenly at a much larger risk of a C-section. Sometimes, an epidural in this instance will save a mother from major abdominal surgery, by allowing the mom to relax enough to dilate or take a much needed nap before beginning to push her baby out. 

Overall, if someone were to ask me what my personal preference is regarding the use of an epidural, I would of course, be honest and state that I prefer to have an unmedicated birth. I prefer it for myself and I prefer it for my child. Is that the right decision for everyone? I cannot say. What I can tell you is that women, generally speaking, are born equipped to birth. Our bodies and our babies know how to do it. It is up to every individual woman to educate herself, so that she can make informed choices for herself and her child. She needs to do this, so that she can feel good about the decisions that she makes and she will ultimately know that she has made those decisions by carefully weighing the benefits against the risks. That is her key to empowerment. It is not my place to judge, only to inform and support.

Best wishes,

Melissa