Let me start by saying that if you want an epidural for your birth, more power to you, go for it! This post is not to judge the decisions of others. It is to ask that the decisions of other not be judged.
Today at lunch I was talking with a coworker who recently decided to go for a home birth for her current pregnancy. As we were talking about out-of-hospital (OOH) birth, another coworker entered the staff lounge and overheard my pregnant coworker saying she was happy to not be going to a hospital because she didn’t want an epidural and thought it would be harder to avoid if she was in a hospital. The newcomer entered the conversation to say:
“Do you know what my nurse said to me about epidurals when I was in labor? Antibiotics were invented for a reason, and epidurals were invented for a reason. Science progresses. There is absolutely no reason to not get an epidural and to be in pain and suffer through your labor.”
I made a bland reply along the lines that being in pain and suffering were not the same thing, but the comment really got to me, probably partially because my pregnant coworker was so happy with her decision to switch to an OOH birth and there was no reason for her to be derided for her desire to avoid an epidural. It is far from the first time I’ve heard such a comment; it is regularly stated by those deriding OOH birthers that there is “no reason” to not get an epidural. The remark, and follow-up statements by the woman, stayed with me, and I began to think of what I wish I had said.
There are reasons to not get an epidural. Just like there are reasons to get one! For some, getting one is the right decision, even if just because they want one, and I do not dispute that.
However, for some getting one is not the right decision. And that seems to be something that many, many people refuse to acknowledge.
I wish I could go back and reply to her again. I would say that there are reasons to not get an epidural, including:
- PositioningIf your labor stalls, if your baby is in a poor position, or if, like me, the last little bit of your cervix simply doesn’t want to get out of the way, changing positions is one of the best things you can do to help things get back on track. Additionally, during pushing many people in a hospital have a baby who gets “stuck”, but simply getting off your back and squatting increases the pelvic opening by 30%. Gravity works even while you’re in labor, and your hip joints and other parts’ positions can be drastically changed by how you are sitting/standing/laying. With an epidural you either partially or completely immobilized, and the range of positions you can achieve is severely limited. This may mean a longer labor, a malpositioned baby who doesn’t want to drop, a cervix that doesn’t want to finish effacing, an “inability” to push out a baby, or many more complications which are created or worsened by being stuck in bed.
- PushingIf given enough time and left unmedicated, virtually all women will have the urge to push. The urge does not not necessarily start right when the cervix is dilated to 10, because at that point the baby often drops down into the opening and it can take awhile for the uterus to shrink to be pushing on the baby again, but once your body is ready the urge is nearly irresistible! Pushing is far more effective with an urge from your body. During my labor, because I was so tired, my midwife gave me the option of having her hold my cervix out of the way while I pushed, which I took. My body was not ready to push, and I had no urge for about the first hour. My pushing was progressing, but it was hard and painful. Once I got the urge, however, there was no stopping me! It felt FABULOUS to push! At one point they even suggested I rest through a contraction and I couldn’t; my body knew its job was to push that baby out and she was coming with or without my consent! In addition to the urge, pushing feels a certain way, and the feelings you have during pushing give you feedback on how to push better. Imagine trying to learn how to “roll your r”s while your mouth was shot full of novocaine and you couldn’t feel your tongue or mouth. Even if you could hear yourself and see yourself in a mirror, it would be much more difficult to learn than if you were getting tactile feedback from your efforts. The tactile feedback a woman gets from pushing is important as well. An epidural takes away or dampens a woman’s pushing urge and her body’s feedback on her pushing. This, again, can lead to many women who are “unable” to push out their baby, though they may well have been able to if they were left to feel.
- Pain is not the same as sufferingPain is a part of life. Sometimes it is to no end but to tell us something is wrong, and once we know something is wrong there is no need for it. However, sometimes it is communicative. Would you want to exercise while completely numbed up to avoid the soreness and pain that can be associated with a good work out session? Of course not! That is pain with a purpose. So is labor pain. Pain is a physical response, suffering is a mental response. It is possible to feel pain without suffering, like when you are achieving a good work out. For many the purposeful pain during labor is worth feeling and does not lead to suffering.
- Lingering NumbnessI have a friend who got an epidural and asked for it to be very light. Since it is not always possible to control how strong an epidural is with that degree of finesse, she ended up with an epidural that left her completely unable to feel anything from the waist down, and whose effects did not wear off until hours after she had given birth. She really disliked that she was unable to stand, walk, or even adjust in bed, and that she felt so uncomfortable being numb, in the first hours of her child’s life. Unfortunately, there was nothing to do but wait for the medicine to wear off. This type of occurrence is not uncommon; it is hard to control exactly how strong an epidural is. Is this a life-changing side effect? No. But neither is experiencing pain during labor. It may be a strong reason to avoid an epidural for some women, just like avoiding pain may be a strong reason to get one for other women.
- Epidural headacheAn epidural is a medical procedure and has a long list of possible side effects like any medical procedure. One of the most common side effects, occurring in up to 1 in 100 epidurals, is an epidural headache. An epidural headache occurs when the epidural needle, which is supposed to be placed just outside the spine, punctures the dura surrounding the spine. This leads to spinal fluid leaking out of the puncture wound. Spinal fluid surrounds the brain, and if too much leaks out the brain tends to sag and rub against the bones of the skull, causing pain. An epidural headache can range in severity, but can be debilitatingly painful. The duration varies from a few days to months or years, with most healing themselves but some needing treatment. A woman may not want to risk this relatively common complication in the first days or weeks of her baby’s life.
- Higher chance of interventions, possibly including c-sectionOne main reason many women have for avoiding an epidural is to avoid the interventions which often come with it. An epidural increases a mother’s risk of longer labor, fever during labor (which leads to antibiotics for mom and baby), perineal trauma (e.g. 3rd and 4th degree tears), and operative vaginal delivery. Some studies show that it doesn’t increase the risk of c-section, but some show it does. For example, one article in OBGYN News (a source definitely not biased towards downplaying a connection) discusses a small study which showed a 30% risk of c-section for women who got an epidural and an 8% risk of c-section for women who didn’t.This larger study of over 2,000 women also found a link between epidural administration and c-section rates. For women who want to avoid these and other interventions, this is a huge reason to not get an epidural.
So to those who berate natural birthers, scoffing, “You don’t get a medal for doing it without drugs!” or declaring, “There is no reason to not get the epidural!” I say, you are wrong. There are reasons to not get it, just like there are reasons to get it. Neither choice is wrong, and the choice should be left for the mother to make without belittlement or scorn.