Getting A Sense Of The Big Picture Makes The Decision Easier
Most women today choose an epidural for the management of pain during labor. But what does this procedure consist of and are there risks involved?
The question of whether or not to have an epidural, as my grandmother advised me to do, is certainly a modern dilemma, and one that hearty mamas in developing countries might still refer to as a first-world problem. The CDC (Centers for Disease Control and Prevention) states that 60 percent of women in the U.S. who give birth without forceps or vacuum extraction do so with epidural anesthesia.
The Epidural came into use in the 1900’s, about 50 years after the discovery of inhalation anesthesia. Back then, the procedure was used to ease pain not assist in labor or delivery and came with considerable risk. In 1909, the first caudal anesthesia was given for labor pains, and a German obstetrician, Walter Stoeckel conducted a study where 141 women had successful delivery with epidurals. His success rate (of reducing pain) was about 50 percent.
My grandma had a fascinating birth story that began just after World War II. My grandfather, a Navy doctor, had been stationed at a very small hospital (using the term loosely) on Guam. Six or seven months pregnant, my 25-year-old grandmother had been prohibited from joining her husband due to her bump, but managed to hide her pregnancy anyway and get on a ship with my father, who was then a five-year-old boy.
After quite a voyage, they landed in Guam — not exactly a destination where most women seek out to have their baby — and some weeks later she went into labor. Chaos ensued as the hospital was full of Marines and my grandfather was the only medical professional there who had even the tiniest experience in delivering a baby. He was so frantic trying to deliver his second son that all thoughts of pain medication were forgotten. It was only at the very end, when she was screaming with agony, that my grandfather gave her a small bit of ether (which was used as a general anesthetic until the 1950’s). Labor and childbirth over, my grandmother was wheeled into the large one-room recovery area full of injured soldiers, where they each took turns holding the newborn.
We all have a birth story with interesting points that stand out and should be shared. But what my grandmother took from hers apparently, and what she shared with me later as I became pregnant with my first child was this: “Take all the medication you can get, honey! Take it.”
Pregnancy Changes Everything
Pregnancy was such an incredible delight to me. From the first positive test (and five more, just for fun) to the first ultrasound, every detail of carrying a child fascinated me. I was more than willing to explore both sides of whether it was better to go natural or opt for the epidural.
What terrified me, and the one word that honestly had kept me from pregnancy so long was this: “episiotomy,” a surgical cut made at the opening of the vagina during childbirth, to aid a difficult delivery and prevent rupture of tissues. As my own belly began to swell, I was surprised at how many women waived that issue away as incidental, an inconvenient afterthought (though, it turns out episiotomies are increasingly rare in a natural birth, and even hospital, setting). The bigger issue was labor pain. Everything else, aside from finally holding a baby in your arms, was just peripheral. And as for the episiotomy, well, those lady parts were going to be off limits for quite some time, and all would heal in time.
What I discovered later was that there was a lot of healing to do, but you were also highly distracted with a baby and minimizing the need for healing is the best way to go, e.g. avoid an episiotomy, and even tearing if at all possible (and it is possible). Yet women were waiving away their birth experiences as a horror show that you must endure to get to hold your baby afterwards. I wondered if there was something these women were missing.
I suddenly had advice coming from all around me. Numerous family members and friends felt compelled to dictate which route I should take for pain management. The entire discussion seemed to involve so many angles. There are some women who have had an epidural and wouldn’t do it any other way and there are some women who forgo the epidural and also wouldn’t do it any other way.
I wondered, does the epidural make the childbirth process better, or worse? And ultimately, what is the effect on mom and baby? I began collecting books, and continued to ask questions — even when my male obstetrician told me to stop reading and thinking so much (side note: if your healthcare professional discourages you from knowing what you’re about to go through and from becoming prepared for it, find a new one ASAP).
Both my mother and my aunt embraced ‘twilight sleep’ in the late 60s and 70s for enduring childbirth, which consists of a prescription cocktail of scopolamine and morphine. My aunt explained to me quite simply that it allowed you to stay awake and know what was going on without remembering any of the pain. Sounds good right? Except it also causes the baby’s nervous system to be “gravely depressed” (not to mention the total disconnect of the mother from the birth of her child and the birth of herself as a new mother).
Of course, natural childbirth was already in full swing too at that time, with many new — and experienced — mothers heavily involved with spreading the word about avoiding chemicals and invasive procedures, becoming one with the whole process, and your baby.
As my stomach grew, I found myself more and more curious about natural childbirth. I wondered whether I was up to the challenge, but I was also quite afraid of the unknown. The idea of that long needle being injected into my back as I hunched over naked on a sterile table had become a central vision I wanted to avoid, as it collided with all of the lifelong ideals I associated with the miracle of birthing.
Societal Pressure: The Perfect Pregnancy
As months passed, I saw that long epidural needle in my mind more and more; in fact, it had achieved monstrous proportions. I was also noticing the great importance our society places not just on being a perfect mother, but also in having the perfect pregnancy and delivery. We are barraged with pictures of superstars and supermodels who gain just 10 pounds, and still look better pregnant than most of us will ever look at any point in our lifetimes.
Maternity wear is a fashion all on its own now, where you are expected not just to look cool but also even put forth some level of sexiness, even after you have gained 40 plus pounds and your nose has turned into a fat red ball. And for all, the question remains: can you give birth without the epidural ;a true nature mama, in control of your body, and ultimately parenthood? Or, are you going to weakly call out for those pain meds, shriek for the epidural, and worry about the shame and side effects later?
What society doesn’t tell you is that you can choose. If you want to labor naturally, you can. It takes preparation, dedication, and support, but if you choose to, you likely will have a natural birth. They don’t tell you that choosing not to have anesthesia during labor doesn’t mean you have no pain management at all. Natural labor pain management includes, hypnosis, relaxation, positioning, and a number of other things most women aren’t told about.
All That Goes Into The Epidural Needle
The epidural was first invented in the 1920’s by a Spanish military surgeon Fidel Pagés. These early epidurals came with hefty risks and were not used for childbirth until the 1960’s and 1970’s.
In Epidural Analgesia for Labor: Current Techniques, authors Marco Silva and Stephen Halpern explain that while it was not unheard of for pregnant women to have the lumbar epidural analgesia administered as early as the 1960s, it became much more popular and accepted in the 70s. And it continued to improve as a pain reliever during labor as the 80s arrived, along with the use of the pump, allowing for much greater ease in administering. The spinal epidural analgesia is the epidural we know today, allowing for great blocking in pain while often (but not always) still allowing women to have movement of their lower body.
The pain of childbirth is known to be epic, but that doesn’t mean that all women necessarily want to avoid it. Though labor is hard work and comes with pain, those women who choose natural birth do so because they know that the pain of childbirth has a purpose. It helps them to give birth in the way that is best for baby. It’s like a secret language between mom and child. Pain helps mom tune into her primal self, and in doing so relieves the pain of childbirth by allowing her body to release oxytocin and endorphins. This natural cascade of hormones is blocked with an epidural.
And many women, including some friends of mine, have been more afraid of the needle than they are of childbirth since the needle is a medical intervention and birth is natural and normal biological function.
According to the Mayo Clinic, the famously long needle is inserted into the small epidural space located just outside your spinal cord, in the lower area of your back. The effects are felt quickly, and while the negatives include a decrease of blood pressure (which could cause the same thing in the baby, called fetal distress), breathing issues, and other lesser complications such as itchiness and headache, it’s their opinion that there is very little risk to the newborn.
However, what Mayo Clinic doesn’t note is that epidural use can increase the risk of slowed or stalled labor, which means a need for pitocin (a drug used to induce labor) or a C-section. It can also increase tearing, and maternal fever, and may affect the ability to breastfeed immediately after birth.
Can You Rock It As A Natural Momma?
For many first time mom’s how the baby will be birthed is an ongoing debate in mind. Women can be quite competitive with each other, and the baby birthing arena is certainly great evidence of that. If you haven’t actually gone through natural childbirth, perhaps you aren’t whole as a mother, perhaps you didn’t do it right, and perhaps you’ll never be able to measure up to the tougher moms, the real moms, the ones who were able to grit their teeth, bite down on leather or whatever it took, and pop those babies out without a drop of drugs.
While every one of the women in my family who had preceded me, from my mother to aunt to cousins, sister, stepmother, was pro-drugs in childbirth, I married into a family, and a mother-in-law, who favored the all-natural route whenever possible. I enjoyed having conversations about alternative health with my new family. I’m generally the person with nothing in her medicine cabinet. I like it like that. But when it came to their grandchildren, things got intense. I was suddenly dealing with an extremely opinionated, older and more experienced woman who was saying no to everything it seemed. No to the epidural, no to bottle feeding, no to a crib, no to breast pumps, no to vaccines, and no to the pill after birth.
I suddenly had a lot of information being thrown at me. I knew that the most important thing to me suddenly was to achieve that pinnacle in life: to be a great mother. But how to please everyone? My husband had bowed out of the conversation long ago, leaving it completely up to me. And his mother, it would seem, was alternately thrilled in telling me delightful stories of motherhood and then sending my blood pressure soaring with horror stories of birth.
As one of my friends reminded me — women just love to scare the hell out of each other about childbirth. On the other hand, all moms like to and need to share their stories, and if it happened to be a scary one, does that mean she should keep it to herself?
A doula/mother I’m friends with shared that, indeed, women are often shamed for choosing to have an epidural. This can be avoided, however, in pre-birthing education where women learn what is best for their own situations, are able to speak with other pregnant moms, and can ask questions. As usual, biases and judgment tend to come out of a less educated forum, as well as one where individuals simply aren’t considering what others might be going through. Because, though natural birth is safest for mom and baby, there are times when they can be incredibly helpful and even necessary to achieve the healthiest baby. For example, when mom is exhausted and can’t continue a vaginal birth without time to rest. Or when a c-section becomes medically necessary.
I asked Carmen Lackett, a Colorado certified and registered midwife at Mother to Mother Midwifery who specializes in home births what happens when a woman changes her mind in the middle of natural childbirth and wants pain relief.
“Most of my clients know that pain relief is not an option, as our form of an epidural is the warmth of the bathtub which helps tremendously for moms to achieve their natural home birth. We do whatever we can do to relieve pain without using medication, using breathing exercises, not tensing up, back counter pressure and moving around into any comfortable positions,” explained Lackett.
“I certainly don’t shame any of my clients who end up going to the hospital to have epidurals,” continued Carmen. “In midwifery, I believe you become a parent from the time you become pregnant, and parents should be informed, but do what is best for them. It’s very important to understand the choices you have in pregnancy and childbirth.”
We discussed Carmen’s own thoughts on using medication during childbirth, as she is a mother of four. Three of her babies were born at home, but she had to be transferred to the hospital during childbirth for one of her children due to complications.
“I did not have an epidural then either,” Carmen said, while she emphasized again that it’s a personal choice. “I’m not comfortable without knowing all the outcomes, and there just haven’t been a lot of studies to come out to say the epidural definitely isn’t harmful for the baby.”
Educated To Go Past The Pain
In Why Natural Childbirth, by Judith A. Lothian, education is presented as a large part of the process, with natural birth not meant to be an episode where women are expected to be “biting the bullet and just letting it happen.” The idea is that women can learn how to handle the process, be informed about what’s happening, and not suffer .
Vera McCaughan is a doula who, along with her colleagues, has seen a huge increase in the use of epidurals, as well as the negatives involved. “I have seen the disappointment and depression following a birth where an epidural was used,” says McCaughan. “Many times the women felt disempowered and I felt it be a contributing factor in some cases of PPD (postpartum depression).”
“Birth is a high initiation filled with multi-leveled complex experiences,” she continues. “An epidural can be helpful, it can also leave echoes of negative emotions and disappointment in the mother. A doula can give mothers support to help her deal with the added layers of complexity that an epidural may contribute to the overall birth experience.” In other words, a last minute plea for an epidural may end up being a regret and mom has to deal with those feelings too.
McCaughan states that postpartum care is important specifically to the use of an epidural which including exercises that are able to nourish the nervous system such as gentle massage to the mother’s spinal sacral area and her legs and feet, as well as the use of acupuncture for physical recovery.
As for my first pregnancy, I ended up delving even further into debate (with everyone, it seemed) as my baby was breech. One doctor wanted to try to turn him manually, another did not. I allowed them to try until the pain was too great. Ultimately, the decision was made for me as my blood pressure escalated and I was rushed to the hospital for an emergency C-section, there having the whopper of all epidurals, barely even able to feel myself breathe.
The conversation of how to handle labor continued with my second child as I then wanted to try a vaginal birth after cesarean (VBAC), and some doctors frowned at that. I went to a wonderful midwife, was planning for a natural VBAC, and then toxemia came on and the blood pressure skyrocketed again. I ended up having three C-sections – all with full epidurals where you basically can’t feel anything up to the chest area. As for how it affected me, it just felt scary during the surgery, as I could barely feel myself breathing. There were not any adverse effects that I remember, although I would have loved to try natural birth.
I realized my story is my story and becoming a mother each time was very special and empowering. Despite things not going as expected, I, like my grandmother, and all mothers really, love telling the stories of each birth.
The bottom line is: however you birth, a baby will earn you a serious badge of courage. As the barrage of information continues, we still must rely on our own instincts to do what is right for us and the new members of our families, keeping in mind that the plan may change at any moment. The point is to be informed, know what your choices are, choose medical professionals that are in sync with your vision and go with what is right for you.
Here’s a great YouTube video depicting the fetus growing in the womb: