The Epidural: To Medicate or Not To Medicate?

One of the major decisions that mommy and her partner/coach will face is whether or not mommy will take pain-killing medication during labor.  Allow me to be direct up front, ultimately the decision will be up to the mommy (remember that it’s the mommy’s pain, not the partner’s/coach’s pain), but the partner/coach needs to understand mommy’s will when the day comes so everyone is on the same page and the appropriate support can be provided by the partner/coach (or coaches if others will be there for labor and delivery).  This is a question that mommy and partner/coach will want to discuss early on in the pregnancy because it might not be cut and dry for either partner.

In order to get some perspective before a decision is made on this one, I recommend doing some literature research on the pros and cons.  I also recommend discussing with friends, relatives, and others who have gone through childbirth to get their take based on real-life experiences.  Note of caution, some folks get very passionate about this issue, on both sides.  Also, remember that even if you go in knowing the game plan, understand and anticipate that things might change on game day.

An epidural is the most common form of pain medication (it is the pain relief of choice for two thirds of all laboring women delivering in hospitals) and the actual drugs involved are usually a local anesthetic coupled with a narcotic.  Based on my research, here’s what I hope is a balanced list of some Pros and Cons of Epidurals:

Pros

  • Epidurals are usually effective at relieving a mother’s pain while allowing her to remain conscious during labor (the medication doesn’t knock a woman out or even maker her drowsy).
  • They allow a woman to push (the mother can usually push with assistance).
  • The mother gets a chance to rest before pushing the baby out.
  • Epidurals can shorten labor by allowing the mother to relax.
  • Medication is easily administered as labor advances (the dose can be instantly modified if the location or severity of the pain changes).
  • Little of the medication reaches the baby.
  • If the mother needs to have an immediate C-section or other surprise surgical procedure, the anesthesia can be adjusted accordingly.

Cons

  • Some might feel like it’s not a natural way to deliver.
  • The woman cannot be upright, and lying down can interfere with the progress of labor.  Some express concern over the possible “slowing of labor”, though studies show that epidurals do not slow down labor “significantly”.
  • Any slowing of labor increases the likelihood of other interventions, such as the use of Pitocin (a synthetic version of oxytocin, the hormone that triggers contractions naturally) and an amniotomy (aka AROM, or artificial rupture of the membranes).
  • The pain relief might not be as great as expected.
  • The mother’s blood pressure might drop, and this can affect the flow of blood through the placenta to the baby.
  • Because of the risk of a drop in blood pressure, the mother must wear a blood-pressure cuff.  The cuff squeezes her arm every fifteen minutes.  This can prevent her from getting needed sleep (of course, so can extreme pain).
  • Side effects include the potential for the mother to shiver, itch, feel nauseated, vomit, and run a fever.
  • Pushing can be more difficult because the woman’s muscles are numbed.  This increases the chances that an “assisted delivery” will need to occur (e.g., vacuum or forceps to get the baby out).
  • The mother might be more likely to struggle with breastfeeding during the first few days after birth (NOTE: there is a great deal of conflicting information about this side effect, which lactation consultants don’t yet fully understand).
  • There is a small chance that the epidural will cause a headache and backache a day or two after (and sometimes for longer).
  • Actually getting the epidural might be unpleasant.  To place an epidural, the anesthesiologist will request that Mom sit still for several minutes, and this can be very, very difficult during contractions.
  • Recent studies suggest that some women are often frustrated by the lack of support, help, and attention from the support team after an epidural.

In addition to weighing the emotional and physical pros and cons of an epidural, here are a few things to also consider in your decision making process.

Some Key Things to Consider When Deciding Whether or Not to Medicate:

  • The quality of the childbirth experience is not necessarily determined by whether or not medications are used – “different strokes for different folks.”
  • All medications affect labor and the baby in some way, but with careful monitoring, serious side effects are rare.
  • Medications might be used for many reasons, such as:
    • medical reasons, including high blood pressure or lack of progress
    • the mother’s extreme discomfort due to the position of the baby, the strength of the contractions or the length of labor
    • fatigue due to a long, hard labor.
  • Your physician or midwife and the anesthesiologist will discuss your options for pain relief and offer suggestions based on your needs.
  • The labor nurses will (or at least should) work with you and suggest other pain relief methods you can use instead of medications, if that’s what you prefer.
  • The labor partner MUST know the mother’s feelings about medications before labor begins.
  • The labor partner MUST provide the mother with support no matter what decision she makes.

As for us…we do have a game plan going in, but I’ll wait to share that with you later based on our experience with the real thing.  In the interim, all you parents out there (especially moms), what do you think about medicating or not medicating during labor and delivery, particularly the use of epidurals?  I’d love to get your comments based on your real-life experiences.

Until soon…thanks for listening.

Comments

  1. Medicate! Particularly if you’re comfortable with your OBGYN. It really makes the experience pleasant, you’re awake just numb and it doesn’t hurt the baby. Medical advancements like this were created for a reason. Take advantage of it!!

  2. Do what is necessary. We didn’t advance in medicine to ignore its benefits.

  3. Janet Cassie says:

    I was in labor for 40 hours. Medicate!

  4. Delaney Hunter says:

    I didn’t medicate with either of my kids and was induced using Pitocin with both. Was I in pain? You betcha. Did I manage? Yes I did. I had relatively quick labor with both my kids – less than 12 hours start to finish on each. While I was tired post labor my recovery was simple. I would absolutely encourage mom’s who want to go natural to try it. I completely agree that if an epidural is what you need then by all means do it but I am living proof that natural labor can be done.

  5. Hazel Howle says:

    Back in my day (hee hee) we didn’t have epidural options…I was a pitocin recipient! You will decide during your experience going in with all the facts. Pain threshold are to each their own! And whatever you choose does not take away from the birth experience for either of you…

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