Updated: Dec 3, 2020
Hey Mama Bears! Are you pregnant and wondering if an epidural is right for you? Maybe you’re afraid of having a needle in your back… but also afraid of FEELING labor… And I’m sure you’ve heard allll of the opinions from “OF COURSE you’ll get an epidural.. You’ll be BEGGING for it,,, you can’t do birth without it” to “Why would you ever even consider the epidural?!”
I’m Jaimie Zaki and I’m a Nurse, Certified Doula, and International Board Certified Lactation consultant here to answer your questions on everything pregnancy, birth, and breastfeeding. Today we’re going to chat about epidurals. Some women love them, some women hate them.. So what gives? Let’s take a few minutes to learn about the pros and cons of epidurals, and then I’ll share my own experiences of birth with and without an epidural!
So, if we’re using the BRAIN model (Benefits, Risks, Alternatives, Intuition, Now/Never) then we would first explore the Benefits of Epidruals.
The number one reason anyone wants an epidural is to experience a reduction in the perception of pain during labor right? The intention with getting an epidural is to essentiall numb the body from the waist down.
Some women need pharmaceutical pain relief because they are so exhausted and have been in labor for so long, often without food or nutrition to keep their energy up, that they NEED to rest, but the ongoing anticipation of discomfort is causing them to tense up between contractions, making them even more tired. This becomes cyclical and creates more tension, which creates more exhaustion and so on. This tension and exhaustion increases cortisol levels (the stress hormone) and can actually inhibit labor. So before you know it, mom is woring 10x harder than she should be and making little progress. If this is the case, an epidural can give mom a chance to rest and regain some energy before she has to focus on pushing out her baby
Another idea some people consider a benefit of an epidural is that if an emergency cesarean is required, then they can ensure they will be awake by having an epidural already in place, versus requiring general anesthesia. While this is a legitimate conversation to have, I hesitate to cite it as a benefit, because in MOST situations, there is enough time to place an epidural for an emergency c-section. It is not considered likely to experience an emergency that would require delivery so quick that there would be no time for an epidural, although it does happen. This is where weighing pros and cons, benefits and risks come into play, and this is when we have conversations about acceptance in birth and realizing we can’t prevent everything.
My personal opinion on this is that I would never get an epidural for this reason alone as I believe it would increase other risks that I choose to avoid, and if I was to have an emergency that required an immediate delivery and therefore GA, then I’d have to just accept that I did what I felt was best, and my body or baby had other plans.
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Risks of Getting an Epidural
There can be long term and short term side effects associated with epidurals For some people they can cause long term spinal headaches (also called epidural headaches). For some people they cause fever or low blood pressure, both of which could result in the need for an emergency delivery. Additionally, the medication mixed into epidurals can have a variety of other side effects that may negatively impact mom or baby.
Epidurals don’t always work. Some women will experience the paralyzing effects of an epidural WITHOUT the pain relieving effects of an epidural. This can be extremely frustrating because it is hard to utilize alternative coping mechanisms when you are immobile, but feeling intense discomfort.
Another risk of the epidural is that it’s TOO intense so that you don’t feel ANYTHING. For some people this is okay. But the problem becomes, when it’s time for pushing, you can’t feel what your body is signalling. If you cant feel when a contraction is coming, you will be told when to push, how long to push for, and you may be pushing very hard which can result in hemmorhoids, increased risk of perineal tears, exhaustion, and a longer pushing phase ( this is why i recommend waiting for your BODY to push.. But we’ll save that conversation for another day)
Likewise, the inability to move around can make it difficult to work WITH your body in labor. While there are plenty of position changes to help facilitate labor even if you’re in bed with an epidural, your mobility is limited, and research shows that being ACTIVE during active labor can shorten your labor and help your baby descend more effectively.
Some women may have health conditions like low platelet counts where epidurals are contraindicated and too risky to even be an option…
So then we need to consider alternatives to the epidural
As far as pharmaceuticals go, an alternative medication to an epidural would be IV pain medication. Typically this will be morphine given intravenously. As with any medication, the benefits and risks of this medication will need to be explored and discussed with your team. This may not always be an option depending on how advanced your labor is. If there is reason to believe your baby will be born very soon, providers typically will not consider morphine as an option because it can result in a sleepy baby (we can talk about IV pain relief in another video!)
Sterile water injections are when two injections of sterile water are placed subdermally in the sacral area simultaneously. It is reported that this is extremely uncomfortable in the moment, followed up with a decrease in sensation of pain
Some women will use a TENS unit to decrease the perception of pain during labor
Hydrotherapy is often called “the midwifes epidural” -- Either soaking in a warm tub or a warm shower, your muscles can relax between contractions more, and even contractions can be perceived with less intensity
Counterpressure, breathing techniques, acupressure, massage, and position changes are all other forms of non-pharmaceutical comfort measures that can be used to cope with labor contractions
Deciding if you want an epidural will depend a lot on your philosophy of birth, overall experience, support, and intuition. I said I’d share a little about my personal experience with epidurals - With my second born (first VBAC) i labored for over 30 hours without an epidural, but due to exhaustion and stalled labor, my intuition told me I needed to go ahead and get an epidural so i could rest. In hindsight, as disappointed as I was to get an epidural against my plan, it was absolutely the right decision. After just a half hour of rest, I went into transition and began to labor down.
With my next birth, I had an unmedicated VBAC, I did not have an epidural as I was giving birth at home. This was absolutely the right decision for THAT labor experience. Because I was more emotionally relaxed, and had nutrition during labor, I was able to focus better on birth and cope more effectively without the epidural.
Sometimes when you’re in transition, even if you’re dead set against an epidural, you might want to get one. When i’m supporting a mom, before labor I tell her to come up with a “safe word” to relay how “serious” they are about wanting an epidural. When i’m working with a mom in labor who i know was very adamant about no epidural, when she first says she wants it, I’ll ask her if she needs in “right now” or if she can get throug three more contractions… If she says she can get through three more contractions, we focus on that and then I mention trying a different comfort measure… On the other hand, if she insists she needs it “now” we will alert the medical team, and find new coping mechanisms while we wait… Sometimes just the thought that relief is coming is enough for mom to relax, and sometimes that will even allow her to progress very quickly and she may end up having the baby before the epidural arrives…
Is it ever too early or too late for an epidural? Some will say no. Here’s my opinion… Getting an epidural before active labor is way too early. And while getting an epidural during transition isn’t “too late” medically speaking, and is very attractive, it doesn’t logically make much sense to me… Getting an epidural requires you to sit very still, and depending on how long it takes to take effect, you could have to lie flat and still for a very long time (or what feels like a long time), if you’re in transition, or about to start pushing, this would be EXTREMELY difficult, and likely MORE painful than what you were already experiencing. Of course the decision is YOURS to make, but this is something to consider ahead of time, before you’re in a fragile emotional state where logic goes out the window…
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So sharing my own epidural experience with you…. I mentioned before that I got my epidural during my vbac due to exhaustion and that it was the right decision at the time and I still don’t regret it. However, it wasn’t “necessarily easier”... It took awhile for the epidural to take (yay being a redhead) -- they kept giving me more medication and then finally i started to feel it… it was JUST enough that i could relax but still FEEL labor, which i liked. That said, it made it harder for me to push when it came time to push because i couldn’t feel the build up of the contractions. I also couldn’t get into the position my body so desperately wanted to move into which was a standing squat (interestingly enough, how i delivered with my non-epidural birth). Another thing that surprised me was I actually felt the “ring of fire” more intensely with the epidural birth than i did with the unmedicated birth -- i have absolutely NO science on that but a few of my friends who’ve experienced both kinds of birth attest to the same experience.
Looking back, I wouldn’t have done either birth any differently. I do believe that had I refused an epidural during the first vaginal birth, I would have probably ended up in an emergency c-section, and I only say that because I think my stress levels would have caused my blood pressure to skyrocket and I think I would’ve started shutting down physically and emotionally.
For my home birth, I firmly believe had I been in the hospital, pitocin would have been encouraged due to a weird contraction pattern, and I believe i would have gotten an epidural out of fear which would have made it harder to birth my 10 pound baby, because I actually had to change positions so many times during pushing, that I think we may have experienced an emergency if i was in the hospital and less mobile. In the future, I do not plan to ever get an epidural again, though.
Jaimie Zaki is an LPN, Certified Doula, Birth Photographer, and IBCLC (International Board Certified Lactation Consultant). Jaimie is an Air Force Wife and cesarean, VBAC, and HomeBirth Mama. Jaimie is dedicated to supporting women through pregnancy, birth, and breastfeeding. Jaimie empowers women to use their Mama Bear Roar and Birth and Breastfeed with Confidence!