I wish medicated birth vs. unmedicated birth wasn’t such a testy subject. As Dr. Sears wrote “Birth is not a contest to see who can cross the finish line with the least medical assistance.” Personally, I love hearing any mother’s labor story, no matter what kind of a birth it was. A new baby is something to celebrate!
Two of my labors involved epidural anesthesia. The last five have been natural. There are pros and cons to both approaches. I remember wanting to kiss my anesthesiologist when he made my pain melt away. But then again, I wouldn’t trade the natural high that comes immediately after an unmedicated birth.
This is the first of three posts about pain management during labor. Part two will cover natural/unmedicated birth. Part three is about the purpose behind labor pain and how it can work to your advantage.
THE EPIDURAL
When it comes to pain relief during labor, the modern epidural can be quite miraculous. However, an epidural is a powerful drug and a medical intervention, so it’s generally accepted that it should never be administered routinely or without reasonable cause; the biological effects on both mother and baby are medically documented. Here is a brief rundown of possible side effects that you should be aware of:
An epidural can slow down your labor and interfere with pushing. An epidural can be felt different ways; it depends on physiology and the particular “cocktail” of medicines used. Generally speaking, the epidurals numb your pelvic nerves and can result in a complete lack of feeling or sensation. This was my experience. When you can’t feel contractions, you must rely on the monitor and coaches for pushing instructions. Lots of ladies do this like champs and come through unscathed, but others (like me) push too hard or ineffectively, which can prolong labor and set you up for more pain after the drugs wear off. Anesthesia can also cause contractions to become sluggish, and lead to the dreaded “failure to progress.” However, an epidural can also have an opposite, beneficial, effect. In cases where labor has been stalled because of exhaustion, extreme pain or anxiety, an epidural can actually help get things going again.
An epidural can increase the risk of tearing. The loss of sensation slightly increases your odds of experiencing a 3rd or 4th degree tear.
An epidural can give you a painful headache or backache. Some mothers experience pain in their backs, necks, shoulders and head after spinal anesthesia. There’s no way to predict whether or not this will happen to you. And unfortunately, some women even report chronic pain or a bruised/sore spot many months after delivery day. However, it appears that medical studies on whether there is a direct causal link between epidurals and long-term back pain, are inconclusive.
An epidural can cause nausea, vomiting, itching and tremors/shaking. These are some of the more commonly reported side effects, but unfortunately, there’s no way of knowing if you will experience them. I got the shakes pretty bad after both of mine; it wore off several hours after birth. My stomach itched quite a bit, too.
An epidural hampers your mobility during and after birth. An epidural generally numbs you from the waist down, so you’ll be stuck in bed and hooked to a monitor, pump, IV and fetal monitor. After your newborn arrives, be prepared to spend many hours in recovery as the medication slowly wears off. Being confined to bed means losing the chance to use gravity to you and your baby’s advantage. (I remember being so jealous of my husband getting to be in the nursery with our firstborn while I was stuck in recovery.)
An epidural may require the use of a catheter. Without any sensation, urinary retention can result, so many hospitals routinely insert a catheter along with epidurals.
An epidural increases your chance of further interventions. Undergoing epidural anesthesia can slightly raise your risk of needing additional interventions like forceps, vacuum extraction or even a c-section, and for various reasons including a drop in maternal blood pressure, stalled or sluggish labor and increased “fetal distress” readings on the monitor.
An epidural can lessen the effects of beneficial hormones naturally produced during and after labor. Epidurals reduce the release of oxytocin (the “love” hormone and uterotonic hormone) and beta-endorphin (the stress-response and pain management hormone) by the mother, thereby blocking or decreasing their beneficial effects. An epidural can also potentially rob you of that incredible super-mom-like “natural high” experienced just after birth, which is hormonal in origin.
An epidural can cost more than non-medicated birth. This will depend on your insurance plan (if you have one). Military plans and Medicaid may fully cover it. It is billed as an additional procedure and will usually involve multiple charges for the medication and for the services of the specialist.
An epidural can affect the baby. The medication’s effect on the laboring mother can have subsequent effects on the baby, and include changes in heart rate, breathing and respiratory issues and sluggishness. However, these are usually temporary problems that wear off quickly. Can the drugs used in an epidural potentially cross to the placenta? I’ve seen and heard conflicting reports from doctors; my own OB told me “yes, possibly,” but if so, the amount would be very small. Theoretically, it shouldn’t happen at all since the epi is introduced into a “closed sytem” (i.e. the mother’s spinal fluid).
NOTE: Being as still as you can during administration of the epidural is very important in terms of preventing complications and discomfort. Proper placement can also make the difference in how effective the pain relief is for you.
It’s always wise to be educated before labor and delivery, and weigh the pros and cons of every intervention with your health care provider. Whatever you and your doctor/midwife decide, I wish you a happy and healthy delivery, and a happy and healthy newborn!
Click here to proceed to part two: Things to Know Before Giving Birth Naturally…
Hey Anne,
I am so glad you wrote this. I was going to write about my births, but I have never had experience with hospitals and epidurals, so I was hesitant to write. I’m going to link this post because you have the experience and can talk honestly.
I don’t think there is any right choice for everyone. It’s about making the best choice for you and your baby.
Thanks for this fab post!
Lisa, you should write about your births! I would love to hear the stories! Thanks for linking and sharing this post with other moms. You’re the best. ~Anne
I was super determined to not have an epidural, so I ignored any and all information about them. That said, I should have read information like this in advance just in case I had had a long labour and opted for one!
I did the same thing with my 2nd, Lindsay! My labor was 21 difficult hours and just before transition the nurse told me “it only gets worse from here.” I completely panicked and ask for the epidural. LOL ~Anne
My second son was a VBAC and I went in with the idea that I would try without any intervention but since I didn’t know what to expect I kept an open mind. That said, my water broke around 12:30 pm on November 3rd after my check up. After yet a second visit with my doctor I was told to hang tight and go to the hospital at 6:30 am November 4th if labor didn’t start on its own. Well, it didn’t but I also didn’t sleep at all due to nerves and waiting for contractions to start. I had some pitocin and things went well for several hours and then suddenly after more than 24 hours without sleep the contractions came on hard and heavy. I was too tired to deal with it so I opted for the epidural and I’m glad I did since he wasn’t born until just after 3 am on November 5th. However I did vomit and dry heave the entire time which didn’t help with my exhaustion so if I were to do it all over again I may have opted to just put my big girl panties on and deal with it.
I didn’t know you had a VBAC, Regan, that’s great! Reading your story I’m thinking to myself “that’s a tough one.” I would hate to be sick during labor (uggh) but then again a drawn-out and painful labor can be completely exhausting. It just really comes down to what you feel is best for your situation, and there’s always going to be some effect that you could have done without – whether you choose natural or medicated. ~Anne
#1 I went in thinking no epidural, but at 3am I was just exhausted and had one. Labour slowed down, fetal monitor went on and showed distress, couldn’t feel enough to know when to push…my second two were very quick (w #3 I *just* got on the hospital bed and out she came…almost a parking lot baby) and I don’t think I would have had am epidural anyway. Just wasn’t for me. Crowning and pushing were awful but still.
Having done both, I do agree that crowning and pushing are no fun, but even with the obvious negative of dealing with pain I do prefer no medication now. ~Anne
Hi Anne,
I can’t wait to read your next post about natural birth! I REALLY, REALLY, REALLY want a natural vbac for my next baby. (Assuming we’re lucky enough to have another one. 🙂 ) I went into my first pregnancy/labor wanting as natural a birth as possible, but didn’t listen when people told me not to get induced and it all went downhill from there. I wish I hadn’t gotten the epidural in hindsight because 1) I progressed a lot quicker than expected and didn’t get it until I was already dilated to 7/8 and 2) The yucky common side effects are a lot more awful than they sound in words. I was nauseous, dry heaved pretty much the entire time I was pushing, shaky, etc. etc. No fun!
Alicia, VBAC’s are great and I’ll be crossing my fingers for you! You’re the second mama who’s posted about being sick from the epidural, and that has got to be just terrible. I did escape that effect, but definitely had the others, so for me (personally) the epidural is a true “last resort” (i.e. either for c-section or a labor so painful or difficult that I can’t cope anymore). The natural birth follow up will be next week! ~Anne
I really did try to avoid an epidural and felt like I had failed when my labor went on for almost 2 days and I decided to get the drugs. It did help me to rest and relax, but the recovery was worse. Next time, I hope things are completely different.
I agree that moms are not often enough educated on the possible drawbacks of epidurals. Not saying they are bad or anything, but so much is becoming routine these days and we need to always do our homework and ask questions. I’m really glad you posted this to help moms be more informed about their decisions.
Fortunately, my epidural didn’t cause any side effects, so I don’t know if I’m just lucky or if lots of women experience that. Either way, I think it’s good to have a balanced approached to everything, and it’s good to know the facts about medicated and natural birth. Sometimes I feel like moms are trying to make me feel like I had less of a birth experience because of the drugs, but it just doesn’t feel that way to me. You’ve done it both ways so you know it’s all about the BABY!
I couldn’t agree more, Laney. And that’s great you didn’t have any side effects at all! ~Anne