The Epidural: Less Satisfying and More Painful Birth?

Pregnancy and birth are filled with many unpredictable features, whether this be your first go at the rodeo or 5^th.

Pain experienced during labor is also unpredictable. Pain may be manageable without medication, or it may become severe and exhausting.

If you find yourself calling the United States your home, then you are among the majority if you opt for epidural pain relief during labor.

Ladies in the U.S. have fewer options for labor pain management than our counterparts in other industrialized nations (such as the UK and Canada). It is uncertain if the excessive use of epidural analgesia is a true preference in the US or if it is simply chosen because of the lack of other presented options.[*]

Interesting, none-the-less….

What is certain is that epidural use is nearly always an elective procedure. Although it can be a useful tool in supporting a laboring mother, the use of epidural medication expands the chance for complications, this does not occur in drastic numbers. Each family has their own comfort level with side effects and risk – what one family may consider safe, another may become uncomfortable. (you can learn more about risks associated with epidural use here and here) 

Everyday, devoted and loving soon-to-be mothers opt for epidural anesthesia pain relief during the birth of their babies.

I was among them, choosing an epidural with my first daughter because I thought it would help with pain and allow me to have a more enjoyable experience. In actuality, I experienced agonizing break-through pain and a cascade of interventions that I wasn’t anticipating (urinary catheterization, artificial rupture of membranes, internal fetal monitoring, use of synthetic oxytocin). 

Was my disillusionment with epidural anesthesia in the minority? 

Higher Pain Recall Among Those Opting for Epidural Analgesia

A remarkable finding from a longitudinal study (2009 BJOG) regarding women’s memory of labor pain found that mothers who opted for epidural analgesia reported higher pain scores at all time points versus those who went without.[*]

Another study (2006 JPOG) substantiates the above findings and also goes to on to provide data that women who received epidural analgesia not only had higher recollection of intense pain at two months and one year but also had greater difficulty forgetting pain 10 months later.[*]

If a mother chooses an epidural in most part to experience a labor that is less painful then one without anesthesia the data above can be sobering.

Research also suggests that pain experienced during labor is not entirely a negative experience, with more then 1 out of 4 women (28%) assessing pain as more of a positive than a negative – suggesting that coping with pain is a rewarding experience for some women.[*]

Lower Satisfaction Among Those Opting for Epidural Analgesia

Although women and care providers may assume that effective pharmaceutical pain relief during labor will ensure a more positive birth experience, there is mounting evidence that the opposite is true.

Several studies have shown that women who use no labor medication are the most satisfied with their labor and birth (times being assessed at time of birth, six weeks and one year after birth).[*][*][*][*][*][*]

Also worth noting, women who cope with labor using non-medical alternatives such as water birth, massage, positioning, focusing and breathing done with the support of another person report more satisfied than with standard pain relief given during childbirth.[*]

Natural techniques utilize a woman’s own strengths and places her in control of her own body. They also have been assessed to improve obstetric outcomes compared to pharmaceutical relief.[*][*] 

Interestingly, the influence of pain relief on satisfaction is not as powerful as the attitudes and behaviors of the mother and caregivers involved. Consider a 2002 study published in the American Journal of Obstetrics & Gynecology which concludes four factors that appear to override pain experienced in labor:[*][*]

1. Personal expectations

2. Amount of support from caregiver

3. Quality of caregiver-patient relationship

4. Mother’s involvement in decision making

This reaffirms the main key to satisfaction and managing labor pain effectively, is to ready yourself in advance – arranging continuous support, accurately understanding pain control options (and the interventions involved) and having an active role in the decision making process.[*][*]

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As much as some might like to discount natural childbirth as a progressive trend among a small number of women, research affirms that women who opt for epidural anesthesia experience more pain, have a more difficult time forgetting the pain, and experience less satisfaction overall.  

Women do not decline an epidural simply to “win a medal” – instead information on different types of pain relief are assessed and balanced against other goals such as walking, pushing effectively, or minimizing maternal/neonatal side effects and/or risks.

How much of an effect an epidural medication can have on a newborn or mother is not easily predetermined and can vary based on dosage/mix of pharmaceutical drug combination, the length of labor, and each individual.[*]

Opting for an epidural anesthesia is one method (among many) that can aid in relief of pain and discomfort during the labor process. This type of pain relief requires a mother to give some control to the hospital staff. It does involve risk and additional intervention.

The decision, rightfully, rests for each woman to make. In due course, researching the procedure and talking others who have may be able to offer different perspectives could help a mother decide on what is right for them.

As the data suggests, most women who choose unmedicated birth (and prepare for it) find the pain intense but manageable and they are happier with their experience afterwards.

Ultimately, what can be said, each woman should use the insight into herself to be the best guideposts in directing her toward a positive decision regarding pain relief during labor.

"You gain strength, courage and confidence by every experience

 in which you really stop and look fear in the face."

- Eleanor Roosevelt

2012 National Rally for Change

Each one of us has the power to make a difference in the care for mothers and babies across our nation.

Have you heard of The National Rally for Change? Finally, this was the opportunity! 

Yesterday - across the nation - women, men and children gathered in support of evidence based maternity care. The goal is to reduce the unnecessary induction & unnecessary cesarean rate in the US by bringing awareness to birthing families.

This peaceful event was held all over the country during Empowered Birth Awareness Week - September 3-7^th.

This was not a protest – this was a public outreach event located where the vast majority of women give birth-local hospitals.

This was not about natural birth versus medicated birth – this was about women being aware of all the options and making fully informed choices about the safety of their (and their baby’s) care.  

History of the National Rally for Change

The first event from ImprovingBirth dot org was held in December 2011. This was a local rally that brought about great change for a local hospital and mothers attending.

Following the rally, the hospital initiated an in-hospital based Doula program and changed triage guidelines to allow labor support people to join moms when first arriving at the hospital. They also restructured their website moving information about cesarean surgery from top to bottom of the page and started featuring natural birth stories.

Can’t wait till next year!
 

Pictures from Vuefinder Photography (check out these and other AMAZING photos here: http://vuefinderphotography.com/) 

Speak the truth,

do not yield to anger

give.

If thou art asked for little; by these three steps thou wilt go near the gods.

 -Confucius

What Natural Childbirth Says About You



 

Sure, there were an ample amount of people in my life that weren’t shy suggesting that I was half crazy for not wanting an epidural with my second pregnancy.
 
I remember talking to friends and coworkers – all of which lent the helpful advice that childbirth without an epidural is ludacris and anyone who willingly chooses to opt out is simply naively brave – wishing me the best of luck, of course.
 
One of my reasons to attempt a natural labor and birth was because I had gained a tendency to favor the natural way of doing things since my first daughter was born. With my first labor/delivery, I was unknowledgeable about what interventions were to be expected in a medicated labor (ex. epidural or induction). I also had no comprehension of the risks those interventions carried for me and my baby. I was mainly focusing on what clothes to buy, what color to paint the nursery and what to register for at Babies-R-Us.
 
There was no one in my life that talked to me about natural labor and birth. Not even my OBGYN.  
 
That’s the thing about learning – it’s hard to unlearn and go back to the person you were before.
 
With my second pregnancy, willingly requesting drugs during labor wasn’t something I would choose anymore. There were aspects about birth that I had learned since then.
 
Whatever a woman decides, it is essentially her choice – however, there is value in researching both options (especially for first time moms) so you are able to make an educated choice. 
 
The choice for at least trying a natural childbirth reflects a certain understanding.

 

 
You Understand that Interventions Add Risk

 

When choosing natural childbirth for my second baby, I did so because I understood that any artificial interruption, even with the best intention, would add risk to both me and the baby.
 
Of course, having a natural childbirth doesn’t mean swearing off all medical interventions in absolute terms. Circumstances may arise when such interventions become life-saving and I am grateful that those interventions are available.
 
Though, lessening the discomfort of contractions was not something I was willing to add risk, however incremental or acceptable they are.
 

The following is a brief list of certain risks that accompany the use of epidural medication during labor:

 

An increase in the length of the first and second stages of labor[*]

 

Decrease in uterine performance (during oxytocin-stimulated labor)[*]

 

An increased risk of instrumental vaginal birth[*]

 

More operative intervention[*]

 

An increased risk of developing maternal pyrexia (fever)[*]

 

A risk of dural puncture (up to 3 out of every 100 women)[*]

 

Increase in maternal hypotension[*]

 

Increase in urinary retention[*]

 

Increase in oxytocin administration[*]

Increased risk for cesarean section for dystocia (three- to six-fold increase)[*]

General risks include:[*]

 

Allergic reaction to the anesthesia used

Bleeding around the spinal column (hematoma)

Drop in blood pressure

Infection in your spine (meningitis or abscess)

Nerve damage

Seizures (rare)

Severe headache

 

You Understand Medicine Passes to the Baby
 
 
An epidural is not an actual medicine; instead it’s the process in which drugs are administered into the body.   
 
The medication will be injected just outside of the sac of fluid around your spinal cord (the epidural space). [*]
 
The drugs administered via epidural are a combination of local anesthetics and short-acting lipid-soluble opioids (usually a combination of narcotics such as fentanyl and sufentanil).[*][*][*]
 
When choosing a natural, drug-free labor, a newborn eliminates the risk of being affected by these narcotics.
 
This means no additional risk of not being able to stabilize heart rate. No added risk of allergic reaction. No added risk of respiratory complications.
 
 
 
 
You Understand Pain is Not Without Purpose
 
 
 
With my first labor, I attempted to avoid the pain when I got the epidural. Midway through, the medication wore off and the pain was horrendous.
 
I was tethered to an IV. I was wrapped up in a fetal monitor. I was inserted with a catheter. I was attached to a hollow wire located in my spine. Laying on my back with limited movement – the only option I had was to ask for more drugs…and hence more risk for myself and my baby.
 
I promised myself that I wouldn’t willingly put myself in that position again.
 
When I found out I was pregnant again, I decided that I would do everything in my power (by researching, preparing physically and mentally) not to find myself in that position again.
 
I remembered what the contractions felt like before the epidural, and honestly, they weren’t unbearable. It was only when I was required to be still, on my back, that they were intense.
 
It was only when I didn’t have the gradual experience of pain that it felt extreme. Imagine going from 1 to a TEN THOUSAND on the pain meter once the drugs in the epidural wore off!
 
In my experience, the purpose of pain during labor was a profound connection and communication with my body and my mind.
 
I moved a lot. I didn’t lay down for very long periods of time. I rocked around. I breathed, deeply.
 
If you look more deeply into what those actions were doing you will see and understand – the pain made me stay vertical and helped the daughter’s head down, it kept my oxygen levels high. It allowed me to find natural pain relief through my own reckoning. 
 
 

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My first daughter acted as a catalyst for so many great things in my life. In experiencing a medicated birth, I was given the opportunity to choose a different path.
 
I was given the opportunity to learn that I must rely on myself to place the effort into choosing the safest and healthiest choices for my life.
 
 
One can anticipate that events will happen during labor that is going to be unexpected and you will have to adjust your plan or even throw it out the window completely.
 
In the end, it’s not about choosing natural birth or pain medication. It’s about agreeing that it is a considerable decision that carries significant consequences.