It’s easy to have the perfect birth plan in place, but as most people know, the birthing process can be so unpredictable. When I was pregnant with my first child, I did extensive research on the pros and cons of epidurals. I ended up deciding that I would like to try to go without an epidural as long as I could and see how labor progressed.The same woman can have very different birth experiences from one child to the next. My doctor is a great friend of mine and I trust her medical advice. I told her my plan to have an unmedicated child birth. She had her children without any pain medication, but told me that there is still a time and a place where epidurals can be extremely helpful.
I like to joke that between both of my births, I was able to experience one complete unmedicated childbirth. After over 48 hours of contractions, I ended up getting an epidural and had my first child a couple hours later. With my second child, I got an epidural as soon as I got to the hospital, but it wore off before it was time to push and I delivered without medication. With my first I was unmedicated for the first two stages — early labor and active labor. With my second I was unmedicated for for the last stage, the transition stage, and for the birth.
While some people are strictly for or against epidurals, the research shows that there are many pros to either decision. It really all comes down to the situation and how labor is progressing. Here are seven reasons to get an epidural and seven reasons not to.
As funny as this one sounds, there is some truth that epidurals can help prevent longterm incontinence. A study out of Australia found that an epidural may protect some muscles during labor -- the kind of muscles that control your bladder. This study included about 400 women. It was discovered that two-thirds of the women who suffered muscle damage did not receive an epidural. This could be for a couple of different reasons. Women who did not have epidurals feel the pressure and feel like they need to push, even when it’s not time. The women who receive epidurals do not feel that sensation as much as rely more on the doctor telling them when to push. This reduces the potential damage from premature pushing. I wouldn’t go determining your birth plan based on this study or anything, but it’s definitely an interesting fact that’s good to know when researching epidurals.
If you are looking into the pros and cons of receiving an epidural for childbirth, one of the things you must be prepared for is that it will restrict your movement. This means that you will be stuck in your bed. There are a number of reasons that the epidural restricts movement. First of all, you won’t be able to feel anything from the waist down. You might not even be able to wiggle your toes. Yes, sometimes the epidural is just right and you can still feel your legs and possibly get to the bathroom with help, but I wouldn’t count on this as it’s the exception rather than the rule. Since you can’t get up and use the restroom, you will have to get a catheter inserted as well. If you didn't already have an IV for fluids, you will also need to get an IV. There is no way you will be able to move out of the bed with all of that, so opt out of the epidural if you don’t like it.
The most common reason epidurals are used during childbirth is for pain relief. It is true that women have been giving birth without pain medication for basically forever. However, many women feel that it would be silly to still undergo that pain when we now have access to safe pain relievers such as epidurals. An epidural blocks pain to the lower half of your body. It provides analgesia rather than anesthesia, meaning that while you feel no pain, you are still completely aware. When I was trying to avoid the epidural with my first child, the nurse gave me a different form of pain medication to help take the edge off. It made me loopy and out of it and I while I still very much felt the pain, I don’t remember much else during that time. To me, that pain medication was awful and I much rather prefer an epidural or pain management as it still allows me to stay aware.
One of the things you need to be aware of when deciding on whether or not to get an epidural is that there are some risks. One of those risks include long term side effects. One of those side effects is that you will possibly have back pain anywhere from a couple days after delivery to a lifetime of back pain in extreme cases. I grew up with someone whose mom was an amazing gymnast. After having her baby and receiving an epidural, she experienced sharp pains in her back and could no longer be a gymnast. While it’s rare that you will experience back pain after an epidural, it is definitely a risk. Another risk is that you could experience headaches or migraines. Like the back pain, you could experience it for a couple days or for the rest of your life. Again it’s not highly likely, but it’s still a risk you need to be aware of.
While some labors are very quick, others may be prolonged. The time between feeling my first contraction and giving birth with my first child was 54 hours. It was exhausting. However, the time from my first contraction to giving birth to my daughter was 12 hours. It was much more manageable and while it was still a tiring process, I found I had more energy during my second labor. Sometimes labor can be so long, and women just need to rest. This can be especially true of first time mothers whose bodies have not endured child birth before. I honestly think it’s great if you have a goal of delivering your baby without pain medication. But if you will be so tired from a prolonged labor that you have no strength to push, that’s not going to help you or your baby. Epidurals can be great for allowing mother to rest.
There are three different stages of labor. The first is the early labor phase. This stage is typically the longest and lasts from the onset of labor until you’re dilated to 3 cm. The second is the the early labor phase which is from 3 cm to 7 cm. And the last stage in the transition phase which continues from 7 cm until you’re fully dilated at 10 cm. Epidurals can slow down the second phase — early labor. This is because it interferes with oxytocin, a natural hormone produced during labor. When you get to the pushing stage, it also impedes labor because of several different reasons. The first is that it makes it harder to push, since you can’t feel anything, so pushing the baby out can take longer. Some women find it helpful to get into different positions to help guide the baby down the canal, and an epidural prevents you from being in any other positions.
In the past, if you were having twins, a premature baby, a breech baby, or a posterior baby, it would be recommended that you get an epidural in case of an emergency. If you already have an epidural, it makes it easier to transition to a caesarean. Although they don’t necessarily recommend it now, if there was an emergency, they would have to give you pain relief medication to prep you for a caesarean anyways and it would take longer. Many twins can be delivered naturally but there can be complications. After delivering the first twin, occasionally the second twin does not move into a head down position. It’s possible that the doctor will have to reach inside to help guide the baby down. Some doctors recommend an epidural in case this procedure is needed. In those high risk pregnancies listed, there is also a higher risk of needing to use forceps, which is also much more comfortable if you have an epidural.
Studies have shown that epidurals can increase the risk of intervention during child birth. This can mean anything from labor augmentation drugs such as Pitocin, needing help from forceps or a vacuum, to even needing a c-section. Since you can’t feel anything with an epidural, you don’t know how or when to be pushing. This can increase the likelihood of tearing or receiving an episiotomy. Epidurals can also increase the risk of needing to use forceps of a vacuum, which can again increase the likelihood of tearing and receiving an episiotomy. If you are trying to stay away from getting an epidural, it would be best to stay away from Pitocin, which can make contractions stronger and less manageable. Many women who receive Pitocin end up getting an epidural. When you add in the other reasons not to get an epidural such as slowing labor, the risk of c-section is greater when you receive an epidural.
One of the side effects of receiving an epidural is that it can lower your blood pressure. This is not good if you have normal blood pressure of even slightly low blood pressure. However, if you happen to have high blood pressure, an epidural can help bring your blood pressure down. This high blood pressure can be detected at any time during pregnancy or while in labor. There are high risk high blood pressure cases when an epidural would not be recommended. Extremely high blood pressure levels are known to affect the blood from clotting adequately. If your platelet levels are too low, an epidural would not be recommended as the epidural needed could cause excessive bleeding. While an epidural could possibly bring your blood pressure down, it shouldn’t be a way to solve your high blood pressure. Your doctor can recommend better ways to help bring your high blood pressure down.
If you are not planning on breastfeeding, this point doesn’t exactly apply to you, but it’s still great information that is good to know. There have been studies that link epidurals with lower breastfeeding rates among new mothers. This is due to the baby’s initial rooting and suckling behaviors which are believed to be slowed down by some of the drugs in the epidural. We already discussed how epidurals interfere with the natural production of oxytocin and how it can slow labor. However, oxytocin is also the hormone that causes the let-down effect in breastfeeding. If you get an epidural, it’s possible that your let down effect will be hindered because of the epidural interfering with the production of oxytocin. This doesn’t do anything for breastfeeding in the long term, but it can set off your breastfeeding journey on the wrong foot. Breastfeeding can be difficult to master, so some people need all the help they can get.
There used to be a time when doctors would never let a woman have a vaginal birth after having a caesarean. However, with proper education from your physician, it’s possible that you can have a completely healthy vaginal birth after caesarean (VBAC). While not everyone is even a candidate, 90% of women who have undergone cesarean deliveries are candidates for VBAC. One of the things doctors will recommend is that you wait at least a year after having your caesarean before becoming pregnant again. This allows your scar longer to heal, making it stronger. Depending on the doctor, some will tell you that you need to get an epidural if you want to have a vaginal birth after caesarean. There are many risks of having a vaginal birth after caesarean, including the risk of a uterine rupture. If you already have an epidural, it will make the transition to a caesarean seamless and quicker in an emergency.
One reason to consider not getting an epidural is that it can make the recovery time longer. This can be for a variety of reasons. Because an epidural can cause your labor to be longer, it’s possible that your body will be more strained from the extra hours of labor and extra pushing. This could definitely contribute to a longer recovery period. Epidurals are also known to increase the risk of tearing and risk of an episiotomy. This requires extra stitches and thus, extra recovery time. Depending on your labor, it’s possible that you recover extra fast while still receiving an epidural. It's also possible that you don’t receive an epidural and spend a long time in recovery. Each birth is different, and it’s impossible to say exactly what will happen. Regardless of what you decide or how your labor goes, it’s good to be informed and know all the risks.
With my first child, I was having active contractions that were three to five minutes apart for over 50 hours. At one point during those 50 hours I even called my doctor and they recommended I come in and get checked just in case. When I was finally admitted to the hospital, I was exhausted. But I really wanted to try and have an unmedicated child birth. After many hours of being stuck at six centimeters, my doctor recommended that I have an epidural to relax. They said it’s possible that it could help speed my labor up. Well, it turns out they were right. Several hours after getting my epidural, I was holding my baby in my arms. Also, it felt amazing to be pain free after enduring labor for that long. Sometimes moms can be so exhausted and tense that they can actually impede the labor process, and an epidural can often help speed labor along.
While spiking a small fever might not seem like a big deal, getting a fever while you are in labor can be dangerous for you and for your baby. Getting a fever while you’re in labor can increase both your heart rate and baby’s heart rate. While it’s not likely, it’s possible that your doctor will contribute baby’s increased heart rate with fetal distress and opt for a c-section. That’s highly unlikely, but completely possible. Even if a fever does not result in a c-section, it can also lead to other things. If your doctor notices your baby’s increased heart rate, they might want to keep baby at the hospital for observation or even antibiotics. Sometimes this can mean that baby will need to stay while you will be discharged. Being separated can be extremely hard on a mother and a new baby, especially is mom is planning to breastfeed.
There are many reasons to get epidurals and many reasons to not get them. The most important thing is that you are educated about your decision.