To epidural or not to epidural?

When we see a woman in labor in television and in film, she is always in the second stage of labor, or what we normally think of as the pushing stage. [Side note to those unfamiliar: this is the shorter of the two stages but often the more suited to made-for-tv movies, hence it's popularity as The Depiction of what a woman in labor really looks like.] And no doubt this image of a woman working hard, seemingly in horrible pain, to birth her baby has contributed to the fear of childbirth that we have today.  That fear may be one reason why pregnant women can be so keen on getting an epidural.  Ah, an epidural....numbness from the waist down so you can't feel those dreaded contractions. Doesn't that sound fabulous? Maybe. Let's explore a few of the facts about epidurals:

  1. Yes, epidurals can numb the laboring woman from the waist down and that can be a huge relief when you are tired and in pain. But what is less commonly known is that epidurals actually lengthen the pushing stage of labor...and by even more than what was originally thought. And a study published last month finds that epidurals are actually associated with a longer labor than had even previously been thought of and as if that wasn't enough, they may also lead to unnecessary interventions by doctors who worry that labor is going on too long.
  2. Aside from longer labors, epidurals also prohibit the laboring woman from moving.  That in and of itself is problematic because we know that one of the best things a woman can do in labor is to move and change position. There are a plethora of reasons why it's important for a laboring woman to move but what might not be as obvious is that movement gives a feeling of control to a laboring woman.  It can feel very disempowering and even scary for a survivor of intimate partner violence or sexual assault to not be able to move on her own, and of course this applies to non-survivors too.
  3. Epidurals numb the laboring woman, completely. Which means that a woman in labor don't feel the pain of contraction. Again, that can be a blessing but it should be understand that it can also add another wrinkle to your labor.  If you can't feel contractions then how will you know when to push? Yes, your partner or another support person can look at the monitor and see when you are contracting.  They can then urge you to ours at that point but ideally, you want to be following your body's urges to push (spontaneous pushing) as opposed to coached or directed pushing.  This is a great video on the benefits of spontaneous pushing, if that is not familiar.
  4. Epidurals will numb the pain but not the pressure. That's an important distinction.  You will be feeling a lot of pressure in your perineum that won't go away until you actually birth your baby. That can be confusing for some first time moms because it basically feels as if you are trying to deliver a baby out of your rectum instead of vaginally! An epidural will not take the pressure away; it will only take the temporary pain of contractions away.
  5. Epidurals aren't immediate.  From the time that you ask for one and the time that you are actually in position, an hour may have elapsed. An hour is what expecting parents (and me!) were told on our tour of The Birth Place at Duke Regional Hospital.  More information from that tour is here.  
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Epidurals can be a wonderful coping tool for a laboring woman who is too tired and feels the need to recharge a bit from her long labor. But, like everything else, the pros and cons should be appropriately weighed before making a decision as to whether or not to have one. As with so many things in life, it's always better to be better informed in advance, during a childbirth education program for example, as opposed to having to make a decision in the moment.

Moms, did you have an epidural?  Or if you are pregnant, are you considering an epidural?  Leave a comment below.  Thank you for reading.

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