We know the top reason to choose an epidural is its amazing pain relief but do you know these other epidural facts? When you make your decision about how to manage the inevitable discomfort of a 7 pound person exiting your body from a passage as narrow as the vagina, being completely numb sounds very appealing. Just also be sure you understand what you might lose when choose an epidural. Epidural anesthesia changes your ability to make choices about your labor, can stop your natural labor and can severely affect your ability to push your baby out.
1. Epidurals take Control Away from You
So many times, I have had a woman with an epidural ask what she can DO to get her baby delivered and just as many times, there is very little she can do. Of course, she can keep trying to push and she continue to tolerate frequent position changes and the peanut ball but sometimes the epidural has taken away so much sensation and motor control and/or has negatively affected perfusion to the placenta to such an extent that she can do nothing more than lay on her back or side and hope for the best. The epidural requires bedrest, IV fluids, continuous fetal monitoring, no food, and often labor augmentation with Pitocin or Artificial Rupture of Membranes. People with epidurals have a much higher likelihood of their baby being delivered by forceps or vacuum extraction which increases the frequency of severe vaginal lacerations (Source).
Keep in mind that labor pain is not intolerable for all women. About 75% of people in labor choose this major intervention, many because they are offered nothing else besides the epidural for pain relief.
If you would like to labor without an epidural, seek a situation (provider, birth site, doula, type of education) where women routinely give birth without epidurals so it is a true possibility.
2. Epidurals Stop Contractions
During birth and after birth, our bodies secrete the hormone Oxytocin which causes uterine contractions, milk ejection and nurturing maternal behaviors. It also helps us cope with pain and sail away to labor land. When we get an epidural and no longer perceive pain, labor tends to fade away.
The cycle that keeps uterine contractions happening and makes them stronger and stronger comes from the sensations/discomfort/pain of the cervix opening and the baby pressing down, stretching open the tissues of the vagina. A positive feedback system causes your brain to release more oxytocin to help you cope with pain.
This subsequent increase in Oxytocin also acts on your uterus to make it keep contracting! More and more oxytocin transports you deeper into labor land as you move closer and closer to the birth. The highest dose of Oxytocin we ever receive is at the moment we give birth, significantly higher than we get with an orgasm (Source).
Labor pain causes the continued secretion of oxytocin. No perceived discomfort, results in no labor.
We are very aware of the increased length of labor with an epidural.
“Importantly, people with epidurals had longer first and second stages of labor and were more likely to have oxytocin augmentation to speed up labor”(Source).
Unfortunately, most people who receive epidurals require some Synthetic Oxytocin (Pitocin) to keep labor progressing. Pitocin can create contractions that are very stressful to the baby. Additionally, it does not stimulate the secretion of prostaglandins that work to soften the vagina and perineum, allowing them to stretch open without tearing. Pitocin does not cross the blood/brain barrier so it causes none of the warm relaxing pain reducing effects of endogenous Oxytocin.
3. Epidurals Cause Temporary Immobility
Not only are your legs paralyzed, but your bladder and pelvic floor are too.
- Although almost everyone is laying down with an epidural, virtually no one chooses to lay down during an unmedicated labor. Any pressure on the pelvis intensifies discomfort so most women choose to stand leaning forward or to kneel. Upright positions are known to facilitate labor progress. (Source).
- Your pelvic floor muscles are paralyzed. Not only does a person lose the usual sensation to push, but their normal anatomical assistants are also not functioning. The pelvic floor muscles help the fetal head flex, extend and rotate. This is why so many people with epidurals need a vacuum or forceps applied to the baby’s head to pull the baby out for a vaginal delivery.
- Women lack the sensation to urinate and generally cannot empty their bladder even if they do perceive the need. This means that either a continuous catheter is placed, or the bladder is emptied regularly throughout the labor. Having your bladder catheterized is a significant cause of hospital acquired infection(Source). Also consider that the process of urinating, which involves sitting or squatting and purposefully relaxing your pelvic floor muscles, is another way to encourage fetal decent and cervical dilation. Many women spend a large part of their labor sitting on the toilet or birth stool because it feels “right”. This is lost when you have an epidural.
Epidurals are Hard to Pass up
We know that avoiding an epidural is a difficult goal these days. A person needs to make a detailed plan if she wants to give herself the best chance at giving birth without regional anesthesia. It’s best to start by addressing your preconceptional health and then move to your provider, your birth place, your education and your labor support.
The Midwives at Midwives of New Jersey listen to and support our clients’ choices even when the choice is an epidural. We appreciate the positive aspects while working hard to mitigate the negative effects of epidurals to keep the birth as natural as possible. When possible, our clients are on their knees on the C.U.B. pillow, squatting on the squat bar and not delivering on their backs with stirrups and drapes.
We offer many alternatives to epidural for pain management including: water immersion/waterbirth, narcotic pain medications and nitrous oxide. We sit with our clients in labor, encourage doula care and bring our Midwife Assistants to be labor support and photographers. Learn more about our labor support practices.
We Encourage you to Consider what is Best for your Birth:
- How much control do you want?
- How natural do you want it?
- How active do you want to be?
No matter your decision, make sure you know your options. The Midwives of New Jersey are committed to providing birth choices for our clients and promoting choice for others. There is not just one way for everyone. You can birth how you wish and have a safe and joyful birth!