Few first-time pregnant women escape unsolicited advice from well-meaning friends. To make things even more confusing, there seems to be two major, but opposing, camps: "Get the Epidural ASAP" versus "Natural Childbirth Is The Only Way to Have a Baby."
Sorting this out can be intimidating. It may take a bit of soul-searching to reconcile your own attitudes toward pain and your philosophy as to what type of birth experience you—not your partner, doctor, or mother—want. As you make these decisions, be sure the doctor, nurse, or midwife who will be seeing you through childbirth understands your instincts and choices.
These days, pain relief in childbirth often means an epidural. During an epidural, anesthesia is injected through a catheter into a space between the vertebra of your lower back and just outside the spinal canal.
Traditional epidurals take 10-20 minutes to work. They anesthetize the entire lower half of your body.
Some variations, known as walking epidurals, combine pain relievers to allow more sensation and numb only the abdominal nerves. Because the walking epidural allows more movement and the feeling of contractions, women are able to feel when to push and help labor along. It also works fast. Pain subsides within two minutes after the two-injection procedure.
The epidural is a significant improvement over previous methods because it allows safe, effective pain relief that allows labor to progress almost naturally. You remain conscious, and little of the drug goes to the baby. In previous eras, the drugs often knocked a woman out or greatly impaired her and endangered the baby's breathing or other vital functions.
The Case Against Epidurals ^
Epidurals aren't without their own consequences and controversies. In rare cases, complications occur due to incorrect administration of the drug. Also there is a risk of side effects like severe headache or drop in blood pressure. As with any form of medication, there is the risk of an allergic reaction to the medication.
Studies have shown that the use of epidurals may lead to longer labor, fever in the mother, or an increased use of forceps to assist with delivery. Researchers are also grappling with whether epidural use leads to increased rate of cesarean section.
Other Pain Relief Options ^
You can receive opiate analgesics through IV that dull the pain but don't eliminate it. In fact, most women still feel pain and the contractions quite intensely using this method. For some women, it's enough to get them through. For others, only an epidural provides the relief they seek.
Opiates can affect the newborn, especially if given too soon before delivery.
Separating the Issues ^
Every woman's labor experience is different. Bodies, minds, and values differ even among close friends. When it comes to labor, they add up to different versions of success. Here's a guide to help you sort out the issue for yourself:
- Reasons I might want an epidural:
- I have a low threshold for pain.
- It's safe for me and my baby.
- It's worked for lots of people I know.
- Why go through the pain?
- I'm not in this for the experience of labor. I'm here to have a baby.
- Reasons I don't want an epidural:
- I handle pain well and I think I can go without it.
- I believe breathing, relaxation, and other mind/body exercises can help me handle the pain.
- There are other pain relief drugs I'd rather try first.
- I don't like the risks associated with epidurals.
- Even though I don't know anything about labor pain, I'm not afraid of it.
- I'm into the idea of experiencing the whole labor and birth experience intensely, without any drugs at all.
Most women have feelings on both sides of the issue, but you'll eventually find yourself leaning more one way than another.
Developing Your Birth Plan ^
Many hospitals now encourage you to fill out a birth plan, so that the labor nurses, midwives, and doctors are aware of your preferences. If the nurses in labor and delivery know you want an epidural as soon as you ask for it, every effort will be made to accommodate your wishes. Ultimately, though, the decision as to whether or not an epidural should be started will be based on your vital signs, the progress of labor, the status of the baby, and the availability of anesthesia personnel. On the other hand, if you say you want to hold off as long as possible, your labor team will work hard to support you in the alternative exercises or medications you've chosen.
Think of your birth plan as mental exercise for yourself and information for the people who are trying to support you, rather than a contract you can't break. Depending on how things go, you may want (or need) to change your mind. It is important to realize that, especially if this is your first baby, it is not possible to predict ahead of time how you will feel or how your labor will proceed.
March of Dimes
The American Congress of Obstetrics and Gynecology
The Society of Obstetricians and Gynaecologists of Canada
Women's Health Matters
Epidural analgesia during labor. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated March 2, 2015. Accessed February 25, 2016.
Epidural anesthesia. American Pregnancy Association website. Available at: http://americanpregnancy.org/labor-and-birth/epidural. Updated August 2015. Accessed February 25, 2016.
Planning your childbirth. American Society of Anesthesiologists website. Available at: http://www.choosegha.com/media/childbirth.pdf. Accessed February 25, 2016.
Using narcotics for pain relief during childbirth: Types & side effects. American Pregnancy Association website. Available at: http://americanpregnancy.org/labornbirth/narcotics.html. Updated August 2015. Accessed February 25, 2016.
Last reviewed February 2016 by Michael Woods, MD Last Updated: 2/25/2016