I have beef with anti-epidurialism (a term I just made up)

Okay, here's my beef.

I'm a little upset about the epidural lesson in a recent prenatal class.

A quick preface before I get into it: I have nothing but the greatest respect for mothers who choose to have a medication-free, natural birth whether at home, in hospital or somewhere more exotic. I, on the other hand, decided long ago that pain meds are my friend. Epidural? Yes please!

Now, post preface: The class wasn't an unbiased look at ways to reduce labour pain. It was a thinly veiled anti-medication lecture given by a transparently anti-epidural nuse.

"There's a whole culture of epidural out there," she said, as if the same culture condoned eating babies. "And if you turn it down, doctors will whisper 'oh, my god, she turned it down' as if you're crazy."

This nurse described natural childbirth as a smooth road with few curves. She described childbirth with an epidural as a paved road with awkwardly angled turns. Something that produces "loss of control" for the mother (at least it did during the one labour she had with an epidural), it makes labour painfully longer and may cause your tiny newborn to be "unco-ordinated with breastfeeding" indefinitely after birth.

"There's crazy research out there," she said. But when probed didn't know any specifics. And when asked what "unco-ordinated" meant and for how long, she stammered. "Oh, not long and we don't really know," finally conceding it doesn't have any long term effects on the baby.

But to a roomful of frightened mothers and fathers-to-be, her lesson was enough to elicit anxious gasps.

What the nurse failed to mention was that labour is really, really painful - so I've heard - and mothers who can't properly control their pain, don't fare well during labour and that's no good for their emerging babies either. The hospital-produced labour and delivery manual says this.

Also, pain levels don't stay constant. They get worse. And there is nothing wrong with being made comfortable during labour by using safe medication administered by qualified doctors and nurses - if one so chooses.

True, painkillers, such as Demerol and epidural can be scary. They do affect the baby while they're affecting the mom. But that's why you can't get an epidural at home. Only in a hospital where they have all sorts of monitors and again, qualified medical staff.

So I was disappointed by the nurse and the prenatal class. It's each woman's choice about how to manage her pain. And she deserves to learn the unbiased facts before making such an important decision.

So, that's my beef.

Comments

[DianaBanana]

I've been made to realize that there's a whole bunch of 'natural labour at all cost' fanatics. It's become such that some of the doctors and midwives I've seen have pushed for labour be pain medication free...even if the mother has decided that she's had enough. 'I always tell my patients it's better to go through the pain then to take medication' is what I got from one midwife. It's very much, in my view, that these doctors and midwives are pushing how they feel the mother must be feeling instead of respecting how the mother actually does feel. 'It's not really that bad' says one. Well, honestly, that's not for her to judge. She's not the one in pain so she can't say how bad it is. She can guess, but a guess does not make it so.

I find it highly unlikely that epidurals cause a reaction in the infant because they inject the medication into the spinal system...not into the blood supply. I've yet to receive an actual answer from anyone about how the localized pain medication of an epidural (as opposed to IV given medication which is put into the blood stream) can actually reach the placental barrier from within a system that doesn't actually come in contact with the infant. 'We're not sure how, but we think it does' is not a real answer to me, and given by a doctor! Especially when there is at least one study that shows that it doesn't have any complications with a newborn*. I'm not planning on an epidural, I'd like to avoid it because of my issues with needles, however if I need one I'm taking it and this blatant hostility towards those who're realistic about what they're probably going to end up using is quite offensive to me. You're not any less of a mother or a person for opting to have something help ease your pain.

/rant (I've been getting a lot of flack on this subject too since I'm still coming up with a birthing plan)

*http://www.ncbi.nlm.nih.gov/pubmed/16417096

[Stephannie]

You may surprise yourself. I, like you was allllll for meds - I thought I would be walking into the hospital, slapping my wrists saying: "Give it to me!"
The start of labour, for most is manageable pain and gradually gets more and more painful. By the time I was ready for medication - which I decided would be morphine (even though I was offered an epidural) - I was four hours in. Because the progression of labour is so slow, you often have the opportunity to build tolerance as well.
My experience was a bit different, my baby was stuck and I ended up having to have a c-section and thus, an epidural...but I looked at it like a challenge, to see how long I could go with out having an epidural.

[Jenn H]

When I had my kids the only birthing plan was whether to have a c-setion or a vbac. I had an epidural and emergency c-section with my first (15 years ago) because he was a footling breach. It was awful and I had a terrible reaction to the morphine in the epidural. I swore never again.

I had "spinals" with my other two children (as well as c-sections) and it was amazing. The freezing wore off in a fraction of the time that the epidural did. I felt great. Even my doctor was surprised at how good I looked and felt after just having a child by c-section.

You couldn't pay me to have another epidural. Ever.

[Elena]

Michele, I am with you: drugs were invented for a very good reason. The holier than thou attitude of "natural birth" fanatics is a pain. The choice is yours.

my son was breached and I decided not to try to have him turned because most non-succesfull turning attempts ended in premature labour and emergency c-section. When I chose to have a planned C-section, one comment was: "oh, if you really want to be cut." The main thing is to have a baby in the safest possible way for mother and child, to this end, a natural birth may not be the best choice.

[Wendy]

Please do what makes you comfortable and try not to listen to the fanatics out there. I have bad memories of being in hospital and being lectured about my decisions by nurses, friends and even the odd complete stranger! That was 21 years ago and it still bothers me. Do what you and your husband feel is right for you and your baby!

[Tanya]

I was desperate (who knows why) for a completely drug free experience. Needless to say, baby had other plans when my water broke and I failed to go into active labour 24 hours later. After 12 hours on the highest dose of Pitocin (also not in the plan!) I was begging for an epidural and still only 2cm dialated. Had I not opted for the epidural I would have likely had to have a c-section, but with the continuous drip of heaven into my spinal fluid I went from 2cm to 10cm in just three hours. I could feel and move my legs freely the entire time. When I was ready to push they turned off the epidural and 10 minutes later my daughter was born. I felt everything, but rest assured its not as painful as people tell you it is. The epidural made my birth experience amazing and i'm so glad I opted to get it. Ignore the fanatics and do what you want in order to make your birth experience as comfortable as possible!

[mm]

Good luck to you in all you do. As a reporter I am sure you are researching both sides of all the issues you are confronting during your pregnancy. It does not matter our education, a baby can make us feel like a complete idiot at times, wait and see. I will suggest you look at medication during labour and the possible effects on the baby, especially when it comes to breastfeeding after birth. Do what you feel is best.

[roxanne]

Many people have a definate opinion about natural child birth. But many forget that every woman, pregnancy and birth is unique. I didn't plan on having an epidural but i was open to it. I gave birth to my daughter one week ago. The nurses respected my opinion, but told me i shouldn't feel pressure to go natural. She told me to listen to what my body. I ended up having the epidural. My labour only lasted 10 hours so i had lots of energy to push and my little girl was pushed out in a half an hour.

To all of the fanatics i have two points for you to consider:

1. What was the infant mortality rate before such medical advancements?

2. If you were going to get a tooth pulled, would you rely on lamaze breathing to reduce the pain?

[sarahz]

Michele, it's all about you during labour- your choice, whatever works for you. I had a midwife, and I know that if I had chosen to have an epidural, she would have supported me in that decision (and trust me, there were moments when I was tempted).

every woman, and every birth is different. you will have your own unique birth story. I wish for you as smooth a ride as possible!

[Joyce]

I thought I was getting epidural once I got to the hospital two years ago. However, my daughter was born 20 minutes after I got there. There was no time for any kind of medication what so ever. My experience tell me is no matter how well you plan, it may always surprise you. Don`t worry when the time come, you know what you need to do or you just do not have a choice. Best of luck!

[KC]

I think keeping an open mind is important. I'm hoping for a natural birth when my baby is born in May, but how will I know until I get there? I have looked into natural birth vs. medicated, however, and I'm not sure that all natural birth proponants are "fanatics". There are many documented reasons why a natural birth is advisable, and certainly most women in the world have no choice but to have one. It's misleading to suggest that epidurals have led to decreased infant mortality rates-- women/babies didn't die of labour pain during childbirth, but of infection, disease, and no measures in emergency situations (such as the baby in a difficult position). Delivering a baby, albeit infinitely more painful, is also a more natural process than having a tooth pulled. Further, most of us are physically capable of doing it naturally, and suggesting otherwise so resolutely only serves to shut down the possibility.

[lilywhite]

What the nurse described was right. If she had painted a rosy picture of the epidural, she would have been lying. Epidural should be your last choice, not your first. Women are made to birth – it’s a fascinating and complex series of steps. If needed, epidurals can be life savers – long labours are especially hard, and epidurals are a welcome relief. It’s great that we have epidurals available, but it’s also important to understand the risks associated with medical intervention of a natural process.

[momofboys]

Hey Michelle,

Your blog posting brought back some strong childbirth memories for me - had my boys in '91 and '94. With my first, when people asked if I was going to have a "natural" birth, I'd respond that as long as the baby didn't come out of my nose, it would all be "natural". Much like you recently found out, people seem happy to fill a nervous new mom's mind with horror stories about epidural side effects and other vague threats.

Like other writers here, I decided to approach my son’s birth with an open mind. Ended up having a 56-hour labour culminating in an emergency C-section - but it was not as bad as it sounds. During the first 24 hours I walked, shopped for baby furniture and ate chocolate cake at Bregman's! At roughly the 36-hour mark I had an epidural, which allowed me to relax through the rest of the labour. The pain was manageable throughout - I'd had worse pain with bad stomach flu - and in the 18 years since then, I've never suffered any of the litany of side effects they warned me about. Son number 2 was a planned C-section, which was also a positive, pain-free, joyous event for baby and for me.

Your childbirth experience will be your own, as is the case for all of us mothers. Sounds like you are (intelligently) letting your common sense be your guide! All the best to you, hubby and the Lentil!

[thordora]

You need to remember that ALL births are different, and that many instructors are teaching after years of intervention heavy procedures where are NOT truly necessary in all cases.

My first birth I had an epidural after being pressured by the nurses, which slowed down my labour, and led to a longer recovery period. My daughter never could latch properly either. However, feeling my hips doing the work to expel her, without the pain, was something.

My second birth happened to fast for anything aside from a bit of nitrous, and while it hurt for a short period, it was manageable and I will never forget birthing my child fully aware of everything-with that clarity I can still feel 4 years later. It was incredible-I've never felt so powerful in my life.

I found labour tolerable, however, I have short labours that end with hemoragging. EVERYONE is different-finding a division and calling one side or the other fanatics doesn't help anyone to find the common ground. There's no sin in having an epidural, any more than there is in trying to go it without one.

It's ultimately your child, and your body. You may change your mind at delivery, and like me, may not have any time anyway. :)

[Chris]

I'm a firm believer in women having the option of having an analgesia free delivery and would hesitate before undervaluing the individual importance of birth to a woman. That being said I firmly disagree with what that nurse told you as it goes far beyond informing you of your choice but unfortunately spreading misconceptions. (I'm sure she meant well)

If people care to read the 2005 Cochrane Review (a systematic review of the existing literature): Epidural versus non-epidural or no analgesia in labour. I've enclosed the link at the bottom. It basically demonstrates no significant increase in rates of c-section, the baby's condition at 5 minutes (APGAR score) or long term back ache.

It does note an increase in operative vaginal deliveries and its not perfectly clear why (I'd presume increase fetal surveillance and increased willingness of the birth attendant to use vacuum/forceps if the patient already has an epidural). There are still also the documented very rare cases of extreme morbidity but those are incredible rare today and are watched closely for. Still worth keeping in mind.

Overall, I think there are many more benefits to having an epidural other than just pain control. It leads to a more stable labour with the possible use of oxytocin (without causing too much pain). It can allow for a much more controlled delivery, reducing tearing of the perineum (sometimes it can be hard for the mother to slow or stop her pushing while suffering). I'm likely biased but I also like having the epidural in place in case of emergencies and a stat section or operative vaginal delivery needs to occur.

Perhaps your nurse trained in an time when epidurals did have much higher morbidity. Its important to realize that change can happen and once an issue has been identified many hard working people work to ensure these techniques are as safe as possible. I just hope people keep that in mind when they listen to advice and make their own choice.

http://www.ncbi.nlm.nih.gov/pubmed/16235275?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=2&log$=relatedreviews&logdbfrom=pubmed

[LTZ]

I am a resident in anesthesiology and therefore giving epidurals. My wife is 5 months pregnant and is starting to seriously consider birthing options. In other words I spend a lot of time thinking about epidurals these days.

For me the most important part of the entire issue is that of choice: at the end of the day it's the labouring woman who is, well, labouring, and so the final decision is hers, period. For the people who are absolutely for or absolutely against epidurals, that's fine. For the rest (probably the vast majority) in the middle the best thing to do is to gather as much information as possible beforehand in order to make as informed a decision as possible when the time comes. Beware of overt and hidden agendas, and be careful with horror stories and blanket statements.

I suppose that because birthing is both a fundamental aspect of being human and done only by women it has become, for many, a profound philosophical issue. Can you imagine gallbladder surgery or wisdom tooth extraction being so loaded? At the end of the day, birthing is an extreme (with all the best and worst possible) and extremely individual experience. The most important part, from where I stand, is that the right to choose be respected.

My wife still isn't sure about the epidural and you can be sure that I won't pressure her.

[Jody]

There may be anti-epidurialism, but just wait until you breast feed or formula feed. If ever I felt like an outcast, it was after enduring 10 days of a screaming, yellow, thinning baby + mastitus, nipple blanching, having my milks ducts drained by the general surgeon in the ER, + zero sleep, AND still having the breast feeding nuts at Peel Public Health insist "You can do it!". Formula saved my sanity and my skinny miserable baby. Whatever you choose, it's no one else's business.

So take the pain meds (or not), breast feed (or not) and enjoy your baby to the fullest!

[hgcm]

I am a Canadian residing in Florida where there is little or no "anti-epidural" movement that I am aware of. When my son was born, I opted for the epidural about midway through 11-hour labour. I don't know how I would have had the energy to push if I had been drug-free for the duration of labour, even though mine was relatively short. It's also important to note that epidurals have changed greatly since our parents' time. My legs felt a bit like Jell-o, but I was not completely numb from the waist down. If I may also pass along a piece of advice from my Ob-Gyn - Don't have a birth plan. Be open to all options. You never know how your labour and delivery will work, and birth plans can lead to feelings of failure and depression. No matter how that baby comes out, you've done a great job!

[Chantelle]

My only pregnancy so far has been with twins. They don't really give you an option with twins - unless the labour progresses blindingly fast, an epidural is put in place due to the high chance of needing to move to a c-section. If there is no epidural you have to be put out completely in the case of a really quick emergency c-section. At least this way you know you'll be awake. With twins, it's just practical. You deliver in the OR. Period. A cast of thousands watched because they were needed. That's just the way it had to be for the babies and I to be safe.

I knew other women in similar boats, and some of them were devastated by the loss of their long-dreamed-about experience. The fact that Mother nature has her own plan didn't seriously occur to them. I was grateful that my babies were alive, having been born at 28 weeks. Pain meds or the number of people in the room were very very small considerations. Someone will always find SOMETHING to critizise, and your should be pleasently surprised if your birth experience goes as smoothly as you hope. As far as pain meds go, be practical. If you won't get through without them, then take them. If you will, but you'll hate every moment, take them. If there isn't time, then don't take them. People make it seem like a hard choice to make... it isn't. Getting pregnant in the first place was the big decision. But don't make a decision today. Wait and see what happens.

[michele henry]

I agree. Deciding to have a child was the big decision. Having the child is the most important thing.
And I plan - even though I don't really have a plan (I agree about the failure thing)- to be as comfortable as possible during labour. And that means an epidural.
I'm not a martyr. The birth, for me, is just a means to a great end.
And thank you all for telling me to have confidence in my choice, whatever that may be - to epi or not.
I am still miffed, however, by the amount of false and misleading information given to women by health care providers who should leave their biases at the classroom door.
At least it's nice to know that so many people are open-mind and well informed! Thank you again for your comments.

[Tanya]

When I was expecting my first child, I didn't know exactly what to expect during labour. I figured I'd wait and see, and if I needed an epidural I'd get one. And that's what I did. I waited, I saw, and I ordered an epidural as soon as we got to the hospital. The birthing experience was very enjoyable after that, I must say.

As for the epidural affecting a baby, how is that so, when the epidural doesn't cross the blood barrier? Your nurse sounds reactionary and out of touch.

My doctor (a mother herself) said that if you break your leg, you would expect to use pain medication. Why shouldn't the same be said for other pain, such as labour pain? Sheesh.

[AnnaC]

I was just buying myself a hot dog on the street and was asked by the woman at the stand if I'm having a baby. I said yes. Nice of her to ask as I'm 8 months pregnant. She said- don't take the needle in your back. I just stared for a moment shocked. No congrats, none of the common questions or statements- simply don't take the needle in your back!

[AJ]

I've had two babies - the first with an epidural, the second totally natural. The minute the epidural kicked in, I felt great, but the problem because I lost control of the pushing. I was so frozen I couldn't push and in the end they had to use vaccuum. It wasn't the worst thing but I generally like to be in control of things so I didn't appreciate the frozen feeling. My natural childbirth was very painful, but the truth is that the recovery time was ridiculously short. The only thing I took was tylenol for a few days afterwards and all the endorphins that come after childbirth made me feel like some sort of superwoman. It was really the most amazing feeling. All of that said, I think that epidurals are different now and patient=controlled, which may have made a difference for me.

[Jacqueline]

I went a very long time without an epidural (unintentional). It was insane. I was writhing in pain on the bed and terrified. Then I had an epidural. It changed everything. I was actually able to enjoy the birth. Epidurals are awesome. We are lucky that we even have them available. Going without one is something to be proud of but I enjoyed the birth experience so much more with one.