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"
RevolutionHealth.com 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