Six reasons to not get an epidural

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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:

  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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.
  6. 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.


Filed under Pregnancy

8 responses to “Six reasons to not get an epidural

  1. Hi! Longtime lurker here… I love reading your posts! I just had my first baby in November, and I went into it not wanting to get an epidural. I ended up needing induced due to preeclampsia (thankfully it was at exactly 39 weeks–and I was already in early labor when I went in for that follow-up appointment!–so she wasn’t *too* early), and when I went into the hospital the otherwise sweet and helpful nurses scoffed at the notion of not getting an epidural. They said things along the lines of “Why would you want to go through the pain if you don’t have to?” and “Everyone gets them!” I blew them off (politely). But I was having super-strong cluster contractions even before getting induced, and because of all the meds I was on to try and help with my blood pressure I was stuck in the bed attached to an IV. Everything was happening fast (I had baby girl within 7 hours of being admitted!), but I was having so much trouble catching my breath through the constant pain. No breaks between contractions from the start. I ended up asking for the epidural after other pain meds didn’t even begin to touch it, and honestly I handled the pain better while sitting up getting the epi than I did the rest of the time. They told me to let them know when I was having a contraction, but it wasn’t so they could stop. They just told me to focus on my breathing and hold still through the contraction. With constant contractions I guess it would have been difficult for them to find a good time to stick me, but I felt like that was a hell of a lot of pressure on me. “Hold still or we screw up your spine and it’s your fault.” So I sucked it up and handled it. But it makes me wonder if it was because I had no choice, I had to handle the contractions like a BAMF, or if I was finally able to handle them because I was actually allowed a change of position… I had no negative side effects afterwards, but I was very frustrated when it came time to push because I could feel absolutely nothing. I couldn’t even tell if I WAS pushing, let alone if I was pushing correctly. The doctor said I was doing well, I was doing it right. But I feel like I could have had her out even faster if I had been able to feel what I was doing.

    I do and don’t regret getting the epidural. I feel like as long as no other issues crop up if I get pregnant again, I could probably handle it without. I really think I would have been able to go without this time if it wasn’t for the IV meds and fluids keeping me in one spot. Maybe I could have handled it anyway, but I don’t know.

    BTW, you’ve inspired me to try baby-led weaning when my Little Bit hits 6-ish months! After I read one of your posts about it and was seriously interested, I started seeing it popping up all over the place. Just thought you might want to know that what you say has an impact on someone out there!

    • Well this comment just made my day :) Thank you for sharing!

      Just to clarify, I am absolutely glad epidurals exist, and I think there is nothing wrong with getting one if you want it! My point was only that there’s nothing wrong with not if you don’t. I can say with 100% certainty that if I had been in a hospital, and especially if I had been tied to a bed, I would have had an epidural. I couldn’t have not stopped saying no, I could only manage to not request a transfer. You are amazing and you did what was best for you, your labor, and Little Bit!

      Have fun with BLW! I love it a ridiculous amount :D I hope you do, too!

  2. You can pretty much write a post on a number of reasons to avoid anything. “Five reasons to avoid restaurants”, “Seven reasons to not get in a car”, “Ten reasons not to go on holiday” and so on. Sure, epidural has its set of problems, but in general it is very safe. It is also important not to forget that statistics regarding epidurals come from academic hospitals, where majority of epidurals are performed by junior doctors in training, and therefore the reported incidence of complications is likely to be higher than that in specialist practice. Also, epidural also has benefits, namely its positive effect on the biochemistry of the newborn and its potential to reduce the chance of chronic pain after childbirth. That would be two reasons to get one!

    Lastly, there is nothing good or beneficial about the pain of labor, and it is no different from the pain you get when you break a leg or get stabbed with a knife. Except that labor pain is one of the most intense kinds of pain a human is capable of experiencing.

    • Your opinion is yours. If you read my piece you’d see I said over and over that if someone wants and epidural they should get one. It should be their choice. My only point was if they DONT’ want one, they are not a fool. There are good and beneficial things about the pain of labor and/or not getting an epidural, just like there are good and beneficial things about getting and epidural. That is why it should be each mother’s choice, not each doctor’s.

  3. Thank you for writing such a wonderful, NONJUDGEMENTAL, and informative post! I gave birth to all three of my children without an epidural, not because I didn’t want it, but because of a back injury that prevented me from getting it. Which I found out during my first delivery when the anesthesiologist asked if I had any previous back injuries and refused to give me the epidural because of the risks. I could have gone to a specialist for my 2nd and 3rd pregnancies who could have cleared me to get an epidural, but after the birth of my first daughter, I knew I would never want one. That was my choice and it certainly helped in the hospital when the nurses were pushing me to get one; and they do get pushy!!! One went so far as to actually get the anesthesiologist who only confirmed that I couldn’t have one. I admit, I gloated a bit :) Both my sister and sister-in-law had epidurals and both had c-sections due to further complications. Whether or not those complications could have been prevented, I have no idea. I do believe there is a coorelation between epidurals and pitocin together. My sister had the epidural and then her labor stalled causing the doctor to put her on pitocin which increased her pain and she needed more medication until finally she developed a fever and the baby was showing signs of distress resulting in her c-section. My sister-in-law just had her baby this morning, so I have no idea what prompted her c-section. Both my 2nd and 3rd pregnancies were induced with pitocin and I’m glad I couldn’t get the epidural. When I wasn’t progressing fast enough for them, they wanted to increase the pitocin and I refused to let them (actually yelled at the nurse to not touch to IV during my 3rd labor, the same one that went and got the anesthesiologist) because I knew that increasing the pitocin would increase the strength and pain of the contractions beyond what I could handle. I was not bound to my bed during either labor, I was up walking, rocking and moving with the contractions and surprisingly (not!) I progressed just fine with no further interventions, no fever and no distress to my babies. I know plenty of women who got the epidural and loved it and a few who hated it. Each woman is different, each pregnancy, labor and delivery is different. Women have to make the choice that is right for them! We inform ourselves about EVERYTHING, an epidural should be no different.

  4. This topic of women’s choices seems to be a big one in the birth world and I understand it’s legitimacy. I like your slant on the issue of it being about women’s choices. This, we all agree is probably at the root of everyone’s concerns. I just keep going back to the same old question about whether or not the baby wants one. We always talk about women’s choices but we never really address the baby’s choices. Would that baby choose to take that drug or this drug…I don’t know and I guess we’ll never know but I do think it’s worth thinking about.

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