Friday, September 26, 2008

A Natural Birther takes on Epidurals

I've been thinking recently about this topic, and wanted to write about it again. I went back and re-read my post Musings on Birthing Naturally, which I wrote three days after having done so, and I must say I still feel all those things.
My reasons for choosing unmedicated delivery have nothing to do with being macho, or doing the 'in' thing, or saying hey, look what I did. It's not about proving anything. It's not about looking down on those who choose differently, or suggesting that I'm superior. I would have chosen this way even if no one ever knew, because it simply isn't about me. It is about what is healthier and safer for me and my baby. It is about the way God designed my body to do this work. It is about the way He intended birth to be.
A couple of months after my birth experience, my sister also had an unmedicated birth. Her baby was quite large and her experience was not so positive as mine. She said that it got her really thinking about epidurals, so she did some research on them. I've added a little research of my own, and wanted to share what we've found. For all you may hear, good, bad, or otherwise, here are the cumulative results from a number of scientific studies (keep in mind that these tend to be funded by the medical establishment, who of course wants us to like epidurals).

  • YES reduce pain for the mother (4 of 4 studies)
  • YES make labor longer, especially in the pushing stage (5 of 5 studies)
  • YES linked to a higher rate of instrument-assisted vaginal delivery and episiotomy (7 of 7 studies)
  • YES lead to the need for pitocin (2 of 3 studies)
  • YES cost more money (2 of 2 studies, plus any insurance company you ask) (and why do you think the medical establishment recommends them so much?! Did you actually think they had your interests in mind?)
  • MAY interfere with breastfeeding (1 study)
  • MAY lead to more cesareans (1 of 5 studies, but it's the most recent)
  • MAY have severe after effects, including spinal headaches or partial paralysis
  • NO no affect on infant apgar scores (1 study)
  • NO not linked to subsequent long-term backache (3 of 3 studies) (although I know some mothers who will disagree with that)
  • NO they do not increase mother satisfaction (2 of 3 studies)
(I have a list of reference sites below)

I will repeat what I've said before--I do not believe that epidurals (or other interventions) are evil. Not by any stretch. I simply believe that they are interventions. In other words, they should never be routine. Do I ever plan to have one? No; but would I refuse one on moral grounds if I felt it was warranted? No. My labor with the Bear was 23 hours with 2 hours of pushing...was I worn out? You bet. Was it hard? Sure. My doula and husband--both knowing my desire for a natural birth--both subsequently told me that if I'd asked for an epidural they would have supported me wholeheartedly. But I never asked for one, why? Because I didn't want it. Because I didn't need it. I know women who have labored for 36 or 63 hours--should they get an epidural? You betcha--if they want it of course. I know women whose babies have died prior to birth, so they must labor to deliver a dead child while coping with the emotion of the loss--should they get an epidural? You betcha--if they want it. Should the average woman with an average labor get an epidural? No. It should never be a routine thing.

Hopefully most of you participated in my informal little survey there on the sidebar... I'm pretty pleased, I got 80 responses, so that's a decent sized sample (for a little one-woman blog). I noticed a few interesting things: of the 45 people who got epidurals, over a third (17) said they still experienced pain. This may have been because the epidural wasn't given properly, but sometimes even when it's done properly the woman has back labor or something which the epidural can't handle. In other words, planning for an epidural doesn't mean you're covered! Even if you plan for an epidural, you should learn coping techniques because you may need them (if you doubt that, just ask the 3 respondents who wanted epidurals but couldn't have them!)
Of those with epidurals, nearly half (19) reported that they had side effects, either at the time (11) or afterwards (8)... So, not only do you have a 30% chance of the epidural not working (or not working fully/properly), but you also have about a 50% chance of having negative side-effects. That's a big ugly number if you ask me! Furthermore, remember those scientific studies? If you get the epidural, you're all but guaranteed a longer labor and have a much higher chance of having an episiotomy or instrument-assisted delivery. In other words, you may have less pain during the labor, but the postpartum healing is going to SUCK.
So are the risks worth the benefits? Well, of the 36 respondents who chose unmedicated births, the vast majority (22) reported 'some pain or pressure' and 3 reported completely painless births. Less than a third reported 'extreme pain'...interestingly, that's the same as the failure rate for epidurals! I think the key difference here is that these women had planned and prepared for an unmedicated birth. This is the group where I would say that an epidural might be a compassionate and appropriate intervention...but may I remind you that they were the minority.

For what it's worth, I will say that I am certain that orgasmic birth can only happen without medication (and seriously, don't you want one of those?!).

Reference sites:
Penny Simkin "Weighing the Pros and Cons of the Epidural"
Marjorie Greenfield, MD "Epidural--Pros, Cons, and Considerations" (she heavily quotes Penny Simkins article)
Marjorie Greenfield, MD "Seven Myths about Epidural Anesthesia" weighs in (they're in favor)
PhysOrg reports an Australian study concerning epidurals and breastfeeding
Severe negative side effects of epidurals and the need for a national database to report them
Less pain but more instruments

A few natural-birth friendly blogs if you need a little inspiration, or just some warm fuzzies:
The True Face of Birth (which has a million birthy links of its own)
Birth Junkie (not currently posting but some great stuff in the archives)
Blithe Birth celebrate birth and pregnancy
Babies and Bellies (please note that this blog frequently posts beautiful but graphic birth videos)
Descent into Motherhood


Becky said...

Great post. :) I was pretty shocked by the amount of people who had negative side effects from the epidural.

I definitely have to agree that planning and preparing for a natural birth makes *all* the difference. You'll also need the right support - no matter how much you want your natural birth and believe in it, if you show up to a hospital with nothing but yourself, your husband, an OB, you'll almost certainly be following hospital policies... and those don't make for a pleasant experience at all. But yes - preparation! I don't think I've ever heard of a woman whose epidural didn't work (or couldn't get one) who didn't think they were in absolute hell while they were laboring. But if you're prepared and have support... labor can be hard, but absolutely a wonderful experience.

Brooke said...

Well, I totally agree about unnecessary interventions! However, until homebirth midwives are more common, most of us have to give birth in hospitals. Hospitals seem to love interventions... I've given birth 3 times. The first I was terrified and wanted an epidural, but due to an under-proficient anesthesiologist and a smaller-than-average epidural space, I ended up with a spinal block. I was totally numb until it wore of when I was pushing. NOT FUN. With my second, I wanted all natural, but I was induced for a stupid reason, so I got a lovely epidural after 10 hours of pitocin and having my water broken. Baby was born 90 min after my water broke, and it was a calm and wonderful experience. For my third, I once again wanted all natural and learned self-hypnosis. Due to a nurse wanting things her way, I ended up unecessarily tethered to a pitocin IV and constant fetal monitoring. I was literally stuck in bed and was NOT happy for the 90 min before baby was born. I begged for an epidural, but the anesthesiologist never arrived, and everyone (except me) knew it was too late for that anyway. I'm not sure I'd say I was in pain, but I was terribly uncomfortable. I suppose the best part was that pushing out my 9 lbs 12 oz baby girl DIDN'T hurt thanks to my hypnosis (my other 2 babies were MUCH smaller).

katef said...

I am in total agreement.. the problem is not the interventions - they are there to save lives and deal with problems... the problem is when it becomes routine for no good reason.

Interestingly there is not much mention of whether the medication in an epidural effects the baby.. I think it is commonly thought it doesn't but I've read recently that it does pass through and does/can effect the baby... wish I could give you a reference but my brain is mush!

Oh and for the record.. with my girls I have a spinal block and a c-section (to save their lives and I wouldn't have had it any other way) and with M I had a natural birth at 42 weeks 3 days - except for my waters being broken at 6cms dilated no other interventions and gave birth to a 4.6kg baby without any trouble at all.

alisaterry said...

I thought I'd mention that one of the side effects listed on epidural package inserts is respiratory distress and respiratory arrest - meaning it could make you have labored breathing or no breathing.

I bring it up because my epidural got my lungs and it was one of the scariest moments of my whole life. They acted like it is pretty normal to have breathing problems - I assume, since none of them would talk to me when I begged for them to help me breathe. Then Connor's heart rate plummeted, they had to stop labor and I had a c-section.

Everything in birth has pros and cons but hospitals like to leave out the cons. Please do your own research before you allow them to make those decisions for you.

nicole said...

I have mixed feelings about epidurals due to some varied experiences with them. I had an epidural with my first baby, but it completely wore off when I was dialted to an 8 and the anesthesiologist never came back to give me more. Plus, I experienced back labor... the worst pain EVER. I could handle the contractions, but it was the pain and pressure in my back that seemed simply unbearable. Anyway, it was just awful. And by the time Celeste finally arrived, I was so exhausted that I couldn't even enjoy the birth at all. I was so out of it that I didn't even feel like I was in the room. It literally felt almost like an out of body experience.

With the other babies, I had epidurals that lasted through the end, and it was wonderful. I felt like I could enjoy and appreciate what what going on, especially the actual birth.
But then again, I feel that there is purpose in the pain, and without back labor, I think I can handle it. So I guess I'm a little conflicted about the whole thing. I'd like to experience it naturally at some point, especially because I feel like I know what to expect and I'm more familiar with the whole process now. Hmmm. I'm not sure what I'll do in the future but I have to say that orgasmic birth thing sounds pretty nice! I'll have to look into that for next time.

Brightonwoman said...

Back labor sucks, no question. I had some, although I think it was not 'full' back labor because while it was rough I didn't find it unbearable...then again I am one of those people who tolerates pain pretty well so what do I know. That said, I think severe back labor *could* be considered a valid reason for an epidural.
BUT, more than anything, I think it's about preparation...there IS a reason our bodies feel sore while in labor--they are WORKING REALLY HARD! No athlete would put himself through a multi-hour workout and expect it to be all fun and comfortable! Having a positive mindset about it (these sensations are good, they are moving me towards birth, I welcome them) makes a huge difference I think. And of course finding (and practicing) techniques for coping with the sensations of labor.

I totally want the orgasmic birth too. Didn't happen last time but I've talked to women who have had them!

Carolyn said...

I had an epidural as pain relief after surgery. It did not work, even after reinsertion twice. It was actually what made me think long and hard about having a natural birth.

I did end up with two natural births. I had back labor with both of them, and it was awful pain, which was lessened with water. Rose was probably the worst of all-- stalled at 8 cm for several hours, transferred to the hospital, scared out of my mind and in serious pain. Finally I was able to push out my huge baby, all 9 lb 6 oz of her, sunny side up and sticking up her chin.

The best thing about having a natural birth? Not having to wait until the medication wears off to take a shower!

Christa said...

Well...I haven't ever refered to my birth story as orgasmic...but I guess that's what it was. I had an epideral that I didn't want that I refused actually, but because of the situation I was forced into it wasn't an option...but it ran out about 2-3 hours before I delivered, and prior to that I was only numb from the knees down after the first hour. I had twins and I guess the best way to describe what happened immediately as each of them and then the placentas were delievered is orgasmic...I would high recommened it to anyone.
I remember being embarrassed though because I had just had three moments of pure bliss while 9 people stood at my feet in a well lit O.R. (just in case something happened to warrant a c-section). I don't think I want that to happen anywhere but home...ever again. I called my mom and was like mom I think uhm that...she said "I told you it would all be worth it!" and here I was all that time thinking people were talking about the

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