Women give birth every day without pain medication. Everywhere you go you can hear and read stories about the women in rice fields, dropping babies and returning to work almost without thought. The tribal women of Africa going off on their own into the bush and giving birth almost with little or no sound, returning to the group with their newborn infant in hand. And in developed countries around the world un-medicated birth is largely normal. But since the invention of the epidural in the early 1900s, laboring in hospitals with pain-relieving medication has become, by and large, what the majority of American women recognize and experience as birth. According to the American Pregnancy Association, over 50% of women asking for epidurals during labor, and an increasing number of women leaving hospitals altogether to give birth in birth centers and at home with no anesthetics available, how can you decide if getting an epidural is right for you?
First off, it helps to know exactly what an epidural is.
"Epi" means outside of, and "dura" refers to the outer membrane of the spine. So epidural literally means outside of the dura.
An article on PubMed Health states this about receiving epidural anesthesia during labor:
When a woman has an epidural, a small amount of anesthetic is injected into the epidural space [in the spine]. The epidural space is filled with fluid and surrounds the spinal cord. Nerves that carry pain signals from the body to the brain (spinal nerves) connect to the spinal cord in certain places. The anesthetic numbs the spinal nerves, blocking the pain signals. For a birth, the medication is injected into the lumbar area, which is the lower part of the spine. If it works properly, you will no longer feel pain in the lower part of your body. But with a low dose you are still able to move your legs, or even get up and walk around with a bit of help and support. An epidural can also be used for partial anesthesia if the woman needs to have a Cesarean section.
Because a single injection is often not enough to last throughout the entire birth, a catheter is usually put in and then attached to the woman’s back. This thin plastic tube is pushed forward into the epidural space using a special needle. It can be used to inject more anesthetic or painkiller as needed. Doctors often do this by hand, or the catheter may be attached to a small pump that continuously supplies small amounts. Sometimes there is a patient-controlled pump. This means that you can give yourself more medication if you need it.
When epidurals are used, a small tube (cannula) is usually put into the woman’s arm as well, so that a drip can be attached to it. This is a safety precaution, for instance because blood pressure can drop rapidly during an epidural. The cannula can then be used to very quickly supply the right drug to help increase blood pressure.
It sometimes takes a while for anesthetists to get the injection in exactly the right place in the back, or they may not manage to do so at all. The dose is usually increased gradually to avoid injecting too much at once. Pain relief is typically felt about 10 to 20 minutes later.
The catheter is placed since you cannot get up to use the bathroom. Some women can decide whether or not they would like an epidural based on the straight-up facts. But there is another way of gaining valuable information that the statistics and facts simply cannot deliver: birth stories. In other words, the experiences of other women who have had epidurals. I am writing this article as a doula and childbirth educator with a lot of book knowledge, but I have no personal experience with epidurals, having had three un-medicated deliveries. So I went to women who had experienced epidurals in birth, and here is what they had to say to you, a woman considering an epidural:
“Don’t wait until the pain is unbearable.” “Don't look at any of the stuff they bring in. They numb the spot before so it really doesn't hurt too much.” “It helps to try and make friends and joke with the person doing it. Makes it go faster and you don't think about it as much.” “Just breathe. Bring some music that you can sing to or listen to. Have a conversation with someone.” “Don't get any pain killers prior to the epidural. The two mixing can be bad.” “Don't be afraid to ask them to wait until a contraction is over to put it in.” “You can still have a doula with an epidural! I would suggest getting one to help support you through the whole thing.” (for more on having a doula AND an epidural, read this article) “You're not stuck just because you have an epidural. Have someone help you roll to your side or back to your back, especially if labor slows down. Consider putting a pillow between your legs while on your side to keep your pelvis opening and baby descending. Think about asking to have the epidural turned off for pushing.”
It is important to note that Epidurals do not make birth safer, and do, in fact, increase the risk of several complications (noted below), but there are benefits to receiving one during birth, should that be desired. Here are a few:
Reduced or eradicated pain (although pressure is still experienced)
Total muscular relaxation
Sleep and rest become possible
Emotional benefit – can reduce trauma and allow you to fully enjoy birthing your baby
The dosage can be turned down when you begin pushing, so you can have a little more sensation (but not pain) to feel while you push your baby out
You have a baby. You are an amazing mother who did an incredible thing. You gave birth! (Same thing is true if you give birth by Cesarean section, FYI).
But before you start thinking that an epidural is a magic wand, there are a few crucial things to consider while you’re writing up your birth plan. When you have an epidural:
You are unable to walk around, stand up, or easily change to more optimal positions for birth.
Occasionally the medicine does not deliver in a balanced way, and you could end up tethered to a bed, only half of your body pain-free while the other side feels every contraction.
Some women get nauseated and have to be medicated for that
Some women get headaches that last for hours, days, weeks, and occasionally months or years after receiving one (see spinal headache)
It can be uncomfortable to receive one. Most women note that it feels like a sting or a pinch that lasts for a moment and then is gone. You also have to sit completely still, even through contractions, while they place it. Compared to contractions, most find this a fine exchange.
Baby can experience a sudden drop in heart rate; if this continues, your care provider will most likely recommend having a Cesarean section to rule out other, more serious, causes.
Epidurals cannot be used in women who have blood clotting problems or are allergic to anesthetics.
Increased need for forceps and vacuum delivery
“But,” you say, “I am afraid of the contractions. What if I can’t handle them?”
“I just can’t give birth without one. I’m a complete wuss when it comes to pain.”
“I have a low pain threshold.”
“The contractions are only going to get worse, right? If I’m not handling them now, I won’t be able to later!” As far as the pain of birth goes, stubbing your toe, breaking a bone, or getting a shot do not compare to childbirth – it is a different kind of pain altogether. It’s a helpful pain, each contraction assisting your baby on their journey out of your body. We know this. And for some women, the understanding that our bodies were made to do this is what drives our desire to have an un-medicated birth. But what happens when you’ve been going for hours, perhaps thirty or more, without sleep or even much rest from the exertion of contractions? What happens when the contractions are longer and stronger than you ever expected and the stress on your mind and body is overwhelming? What happens when you are barely coping, and just so exhausted, and it’s no longer the best option to continue without more medical support? You let go. You get an epidural. And you have your baby. No one can predict how labor is going to go exactly. How long it will be, how hard it will get, or how well you will cope. The very moment you feel like giving up because you can’t handle it anymore is most likely a sign you’re entering transition – in other words, you’re just about to have your baby! You’re so close! Don’t assume your labor will go on for five more hours and only get more painful – assume instead that you’re right around the corner, and that you can do it, and allow your birth team to help you have the natural birth you desire. Or get an epidural with confidence, knowing it’s just what you need for that final stretch. It’s a tool to be used whenever you decide you need it. No one should ever force it upon you or guilt you into it. Your husband, mother, doctor and anyone else in the room with you don’t enjoy seeing you in pain, and they may ask you to get an epidural over and over again, mostly out of love and concern, but also so they don’t have to see you experiencing something so painful and hard as birth can sometimes be. Be sure you feel calm, unpressured, and peaceful as possible about it. Remove fear and self-limiting thoughts from the equation. Ask yourself if you really want one, and if it’s really best for you and your baby. Then make the decision to get an epidural, either before labor or during, with confidence. Allow yourself to feel the joy of giving birth and receiving your baby into your arms, however that is accomplished for you. The best thing to remember is that YOU are powerful. YOU can birth this baby. And YOU are the only person who knows precisely what is best for you and your baby.
If you want an epidural, get an epidural! But do it with confidence and love--not doubt, guilt, or fear.
Be informed. Know what to expect. Surround yourself with support.
Give yourself the opportunity to feel birth as it is – a powerful, incredible experience that you and your baby will remember the rest of your life. Put yourself in a place of joy, excitement, anticipation and love. If an epidural gets you to that place, then get an epidural. In making many of the decisions I’ve made in my life, I am glad for the words of this famous poem by Robert Frost, titled “The Road Not Taken.”
Two roads diverged in a yellow wood, And sorry I could not travel both And be one traveler, long I stood And looked down one as far as I could To where it bent in the undergrowth; Then took the other, as just as fair, And having perhaps the better claim, Because it was grassy and wanted wear; Though as for that the passing there Had worn them really about the same, And both that morning equally lay In leaves no step had trodden black. Oh, I kept the first for another day! Yet knowing how way leads on to way, I doubted if I should ever come back. I shall be telling this with a sigh Somewhere ages and ages hence: Two roads diverged in a wood, and I— I took the one less traveled by, And that has made all the difference.
Happy Birthing!