Few first-time pregnant women escape unsolicited advice from well-meaning friends. To make things even more confusing, there seems to be two sororities: "Get the Epidural ASAP" versus "Natural Childbirth Is The Only Way to Have a Baby."
Sorting this out can be intimidating. It may take a bit of soul-searching to reconcile your own attitudes toward pain and your philosophy as to what type of birth experience you—not your partner, doctor, or mother—want. As you make these decisions, though, be sure the doctor, nurse, or midwife who will be seeing you through childbirth understands your instincts and choices.
These days, pain relief in childbirth often entails an
epidural. During an epidural, anesthesia is injected through a catheter into a space between the vertebra of your lower back and just outside the spinal canal, numbing feeling from the waist down.
Traditional epidurals take 10-20 minutes to work, and they anesthetize the entire lower half of your body.
Some variations, known as
walking epidurals, combine pain relievers to allow more sensation and numb only the abdominal nerves. Because the walking epidural allows more movement and the feeling of contractions, women are able to feel when to push and help labor along. It also works fast. Pain subsides within two minutes after the two-injection procedure.
The epidural is a significant improvement over previous methods because it allows safe, effective pain relief that allows labor to progress almost naturally. You remain conscious, and little of the drug goes to the baby. In previous eras, the drugs often knocked a woman out or greatly impaired her and endangered the baby's breathing or other vital functions.
Epidurals aren't without their own consequences and controversies. In rare cases, complications occur due to incorrect administration of the drug. Also there is a risk of side effects like serious headache or drop in blood pressure. As with any form of medication, there is the risk of an allergic reaction to the medication.
Studies have shown that the use of epidurals may lead to longer labor, fever in the mother, or an increased use of forceps to assist with delivery. Researchers are also grappling with whether epidural use leads to increased rate of cesarean section.
You can receive opiate analgesics through IV that dull the pain but don't eliminate it. In fact, most women still feel pain and the contractions quite intensely using this method. For some women, it's enough to get them through. For others, only an epidural provides the relief they seek.
Every woman's labor experience is different. Bodies, minds, and values differ even among close friends. When it comes to labor, they add up to different versions of success. Here's a guide to help you sort out the issue for yourself:
Most women have feelings on both sides of the issue, but you'll eventually find yourself leaning more one way than another.
Many hospitals now encourage you to fill out a birth plan, so that the labor nurses, midwives, and doctors are aware of your preferences. If the nurses in labor and delivery know you want an epidural as soon as you ask for it, every effort will be made to accommodate your wishes if and when the time comes. Ultimately, though, the decision as to whether or not an epidural should be started will be based on your vital signs, the progress of labor, the status of the baby, and the availability of anesthesia personnel. On the other hand, if you say you want to hold off as long as possible, your labor team will work hard to support you in the alternative exercises or medications you've chosen.
Think of your birth plan as mental exercise for yourself and information for the people who are trying to support you, rather than a contract you can't break. Depending on how things go, you may want (or need) to change your mind. It is important to realize that, especially if this is your first baby, it is not possible to predict ahead of time how you will feel or how your labor will proceed.
The American College of Obstetrics and Gynecology
March of Dimes
The Society of Obstetricians and Gynaecologists of Canada
Women's Health Matters
Epidural analgesia during pregnancy. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated April 2, 2012. Accessed September 16, 2031.
Epidural anesthesia. American Pregnancy Association website. Available at: http://www.americanpregnancy.org/labornbirth/epidural.html. Updated August 2007. Accessed June 17, 2012.
Planning Your Childbirth. American Society of Anesthesiologists website. Available at:
http://www.asahhttp://www.asahq.org/sitecore/content/Lifeline/Anesthesia-Topics/Planning-Your-Childbirth.aspxq.org/. Accessed June 17, 2012.
Last reviewed June 2012 by Brian Randall, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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