Doulas attend all types of birth. We don’t take only clients who want unmedicated deliveries. We won’t pressure or bully you into doing things naturally. And we most definitely are not disappointed when many of our clients ultimately opt for an epidural. In the U.S., about 60% of women receive an epidural of some kind during labor. In many hospitals this number is higher. For women birthing with the assistance of a doula, the percentage is a bit lower.
If you’re pregnant and in the process of learning about your comfort measure options, read on to discover all there is to know about epidurals. As I’ve discussed in previous posts, it’s always a good idea to look at the Benefits, Risks, and Alternatives when making decisions about your birth experience.
What are the Benefits?
Pain relief. Epidurals are highly effective at relieving pain during labor and delivery. A needle is inserted into the spinal column through which a cocktail of medications is given. Depending on the mix, you might lose all sensation below the belly button and subsequently all feeling of contractions. Or, you might retain some feeling and contractions are simply numbed. Epidurals are widely considered the most effective medical pain management tool for labor.
Tension relief. Labor can be long. Fatigue often sets in and moms can feel too tired to continue without relief. An epidural can provide a welcome rest period. Many moms with epidurals find that they are able to sleep or, at the very least, rest more comfortably for a few hours before birthing their babies. For many, an epidural relieves tension and stress that has been building since early labor.
Relatively safe for baby. Compared to other pain medications given intravenously, epidurals are considered safe for your baby.
What are the Risks?
Partial effectiveness or ineffective. A good epidural blocks the desired amount of feeling equally on both sides of the body. Sometimes, only one side of the body feels numbness or loses feeling, leaving the other side to handle the pain and discomfort. It’s also possible for an epidural to not work at all. It is gut wrenching to watch a mom who is very much looking forward to pain relief realize her epidural didn’t work. At times it takes an anesthesiologist multiple tries to get an epidural placed correctly.
Might not feel the urge to push. The pressure in your bottom, also known as the urge to push, is typically greatly diminished or altogether disappeared when an epidural is present. You might not know when you’re having a contraction and therefore, might not know when it’s appropriate to push. And because you might not know when to push or be able to feel how to push effectively, you are more likely to have a forceps or vacuum assisted delivery. While these devices can be helpful, they are also more likely to cause tears to the perineum.
Domino effect of interventions. This is the risk least discussed by medical providers, but the one which birthing couples should be most aware of before making a decision. In deciding to get an epidural, you are also consenting to:
continuous fetal monitoring, which means your belly will now be banded with two devices that track your baby’s every movement and heartbeat for the remainder of labor;
an IV being placed in your hand;
frequent, routine blood pressure checks;
oxygen monitoring;
restriction to your bed;
and likely, placement of a catheter.
Other potential dominos:
pitocin, because labor can stagnate when epidurals are introduced, especially if they are used too early (more on that later);
oxygen mask for mom if it appears your baby is in distress due to low oxygen and a drop in mom’s blood pressure;
c-section, because your baby’s distress is not resolved.
Spinal headache. About 1 in 100 women who get an epidural (or spinal block which is what’s used during c-sections), will get an awful, nauseating headache afterward. Typically it is severe when sitting or standing upright but goes away when you lay flat. It’s easily remedied by your anesthesiologist.
What are the Alternatives?
Movement. Not only does getting up and moving around typically help labor progress, it can allow you to more effectively deal with the pain and intensity of contractions. Walking, dancing, lunging, sitting on a birth ball, and doing yoga are all helpful comfort measures.
Hydrotherapy. Water is a naturally healing, comforting element that many moms find helpful during labor. Even if the idea of giving birth in a tub doesn’t do it for you, laboring in one might. Standing or sitting on a birth ball in a shower is also a great tool for pain relief.
Massage and acupressure. Not a birth has gone by that I haven’t applied counter pressure on a mom’s low back. Firm, consistent massage on a birthing mama’s back, hips, legs, and shoulders is often hugely helpful in relieving discomfort. If your partner isn’t confident about touching you and providing this type of relief, I highly recommend hiring a doula. You might also consider having your partner learn your acupressure points for pain relief.
Nitrous Oxide. Many hospitals and birth centers are reintroducing the use of nitrous oxide during labor. You control the mask, breathe into it during contractions, and pull it away in between them. The effects of the gas only last while you’re breathing it in. For many moms, this is a happy medium of medical pain relief that gets them through the most intense part of active labor and into transition.
Visualization, relaxation, hypnosis, meditation. The mental game that is played during labor is different for each birthing mom. If you are able to get out of your head, stop analyzing your progress, and let go of control, the pain and discomfort associated with contractions can be lessened. Utilizing visualization techniques and turning inward through self hypnosis or meditation can do just as much for some moms as an epidural can.
Other Considerations
If you know you want an epidural during your labor, discuss with your provider appropriate timing of when you’ll get it. Although your provider might say you can get your epidural as early as you want, I strongly caution you to wait until you are well into active labor before the needle is placed. Getting an epidural too soon increases the risk of it wearing off and the need for pitocin to augment your labor. I understand this is particularly difficult for first time moms to swallow since you have no basis of comparison for the intensity of your contractions. Having a knowledgable doula and supportive provider can help you time your epidural to be its most effective.
If you know you don’t want an epidural and you’re birthing in a hospital, be prepared to preemptively tell your care team not to even mention it. Give yourself permission to talk about the intensity or pain without fear of being pressured into an epidural. Having a code word that you, your partner, and your doula all know can help give you that space to experience your contractions honestly and without fear of being bullied into something you don’t really want.
And finally, remember that whether you choose to get an epidural or not is entirely up to you. As long as you are well informed and feel supported in your decision, there is no wrong choice.