If you've ever taken a prenatal class with me you know that I am a huge advocate of informed choice. I strongly believe that an educated birth is an empowered birth.
I often refer to the acronym BRAIN as a metric to assess your birth choices:
B-What are the BENEFITS?
R-What are the RISKS?
A- Are there ALTERNATIVES?
I -Use your INTUITION
N- What would happen if I do NOTHING?
Well, one of the more major choices you will need to make when getting ready to bring your baby into the world is whether or not to have a medicated birth. And, in particular, whether or not to have an epidural. Currently in Canada, about 60% of women choose to have an epidural. With so many women opting for an epidural you might assume that epidurals are completely benign. Well, you would be wrong.
Let's start with a simple description of an epidural. An epidural is without a doubt an effective method of pain relief. The actual anesthesia is most commonly a combination of a narcotic, (usually an opioid like fentanyl), and a local anesthetic that will numb the nerves in the uterus and cervix, but will also numb the entire lower part of your body.
Generally, there are two different types of epidurals: a standard epidural and a “walking” epidural. Now, a “walking” epidural is really a misnomer. The reality is that you will likely be confined to your bed, but it will allow for more freedom to move in bed. The primary advantage of a walking epidural is that you will be able to participate more actively in the 2nd stage of labour “the pushing stage”.The primary disadvantage of a walking epidural is that it doesn’t provide as much pain relief.
How and when is an epidural administered? Typically the epidural will be given when your cervix is dilated to 4-5 centimetres. An anesthesiologist will ask you to either sit up in bed or lay on your side and will then inject a local anesthesia into your lower back to numb the area. Then a very thin catheter is placed into the space surrounding the spinal nerves. The medication will then be delivered through the catheter.
What are the Benefits? Quite simply the key advantage of an epidural is that it will reduce or eliminate the pain of childbirth. As Penny Simkin, childbirth educator and author of the best selling book,:The Birth Partner, makes clear, "When it comes to coping with childbirth, there is a difference between pain and suffering." There is no way to sugarcoat it...childbirth is painful. That said, there is no need to suffer. If you are coping well with each contraction, you may not want an epidural; however, if your pain crosses the threshold to suffering you may want to consider an epidural-especially if you’ve been labouring for a long time. An epidural will allow you to rest and relax and may improve your overall satisfaction with your birth experience.
Now, what are the Risks or Side Effects? Some women experience fevers, headaches, backaches, nausea and difficulty urinating. In rare cases, an epidural can trigger a seizure or cause temporary or permanent nerve damage.
An epidural may cause your blood pressure to suddenly drop, which may inhibit adequate blood flow to your baby, requiring further medical interventions.
Depending on the type of epidural you choose, the 2nd stage of labour, the "pushing stage", may be difficult and additional interventions such as forceps or vacuum extraction may be needed and in certain cases a caesarean section may be necessary.
An epidural often causes your labour to slow down which will likely lead to a cascade of other medical interventions to augment or speed up your labour.
An epidural WILL absolutely interfere with the production of the natural birthing hormones. For more information on the natural birthing hormones I would highly recommend reading Dr. Sarah J. Buckley’s book, Gentle Birth Gentle Mothering.
And, lastly, you may be wondering if an epidural can effect your baby. Well, although the research is ambiguous, most studies suggest that while in-utero, your baby might become lethargic and have trouble getting into position for delivery. Additionally, epidurals have been known to cause respiratory depression and decreased fetal heart rate. And, lastly, studies suggest that epidurals may have an effect on how well your baby is able to breastfeed.
Are there alternatives to having an epidural? Absolutely! Yes, there are many medical and natural alternatives. I will have to write another post on the alternatives soon:)
So, most importantly, trust your Intuition and know that the choice whether or not to have an epidural is yours and yours alone to make.
From my heart to yours,