We're told there is a way to bypass the pain of childbirth and make this journey easier. But this route may not be risk free, it may actually be more harmful than good.
It has become a norm in our society to make things easier, quicker and faster. We've gone from the natural unfolding of things to a man-made process. One example being the farming industry, going from slow growing crops and livestock to trying to speed up the process for more frequent, larger harvests. Another is the birth industry; we've moved away from physiological birth and allowing a woman's body to work through labor as God intended, to wanting it to be quicker and easier. But we can see in both of these industries that the risks usually outweigh the benefits and instead of it simplifying a circumstance it leads to it being more complicated.
Does an epidural one hundred percent guarantee that you won't feel anything during childbirth, as it is said to do? Is it worth the risks? In this blog we will answer these questions plus go into more detail about an epidural and why you may want to think twice when considering this common, but not always necessary, medical intervention during labor. My intention is to provide information about the epidural to provide those debating whether to get one or not with what they need to make an informed and empowering decision. This blog is not intended to make those who have received an epidural in the past feel shameful or regret their decision. Unfortunately, many epidurals are given without true informed consent and if that is the case for you, I am so sorry. This doesn't have to be your story moving forward.
What is an Epidural?
The Epidural is an injection into the outer layer (Epi) of the spinal cord (dura.) It is meant to numb the lower half of the mother I labor, so she is only able to perceive the pressure of contractions and not feel the pain. It is also used to relax the mother and allow her to rest in between contractions. The rest and relaxation from an epidural can be medically necessary. For example, in a situation where the mother is completely exhausted from prolonged labor, putting herself and the baby at risk. There is the possibility of the epidural placement causing pain, and, on occasion, the epidural is not as effective as promised or provides inadequate pain relief. About 60-70 percent of women giving birth will get an epidural and unfortunately there are many accounts of those women who claim the epidural isn't actually effective. Or that the epidural placement was more painful than childbirth.
The medication used in an epidural was once morphine but has changed over the years to a mix of narcotics including fentanyl. Many speculate the reasons why the drug changed; some believe because fentanyl is more cost effective. Depending on the anesthesiologist you may get a concoction of more or less fentanyl. Fentanyl is an opioid drug like morphine however it is 50 to 100 times more potent. The medication is known to cross the placenta and enter the blood stream of the fetus. How alarming! “The odds of positive neonatal fentanyl screen results increased 4-fold for every 5 hours of maternal exposure to labor analgesia.” Studies have been done that show high amounts of the medication in the mother and babies blood up to 72 hours after birth. How long you have an epidural determines how much medication your baby receives and what is present in their system after birth. Many in the addiction and recovery sphere speculate whether or not such early exposure to this powerful drug has implications on the person in whether or not they will abuse substances in the future. It is claimed by doctors that the amount of the narcotics in the epidural is so small that it is practically harmless (however, we now have studies that show these drugs in the newborns blood), but my thought is when else would we intentionally ingest or consume a substance that could be even relatively harmful to our baby?
Does the Epidural impact breastfeeding?
In addition to it potentially sedating the mother and making her less responsive/ aware after birth, it is also shown to negatively impact mother-infant bonding which in turn can harm the early stages of breastfeeding and a mother's success in breastfeeding long term. This medication is also shown to slow the process of a mother's milk coming in, this is when the mother receives her full supply of milk that matches the needs of the newborn as opposed to the colostrum that the baby receives when breastfeeding for the first few days. In some instances, an epidural may lead to a cascade of intervention resulting in the infant needing to be separated from the mother. This separation is typically associated with the newborn being formula fed and the mother not getting the breast stimulation from the newborn leading to a lack of milk supply. Statistically women who receive an epidural are less likely to breastfeed at 6 months. If breastfeeding is your goal, it may be worth thinking twice before getting an epidural.
The Cascade of Intervention
The Cascade of Intervention is essentially the overmedicalization of birth. "Maternity care in the United States continues to be intervention intensive despite substantive evidence that the routine use of intervention without medical indication increases risk for mothers and babies." The cascade occurs when the side effects of one intervention need to be managed, and another intervention is introduced, so on and so forth. It is common in a hospital setting one medical intervention will lead to this cascade, ultimately resulting in surgical birth or a C-section.
For example, a woman who receives a medical induction using the drug Pitocin will experience unnaturally painful contractions and is more likely to get an epidural. Once the epidural is placed contractions may start to slow or stall requiring more Pitocin. More Pitocin in most cases leads to more epidural and the combination can cause maternal and fetal distress resulting in emergency C-section. Another example would be because of the lack of sensation a mother is unable feel contractions or push properly and will then, likely to need an assisted vaginal delivery either through the use of forceps or a vacuum. The reasoning behind the cascade of intervention really boils down to the fact that no intervention comes without side effects. Research shows that women who receive an epidural are 2.5 times more likely to have a C-section when compared to those without an epidural. That is 12 out of 100 women who receive an epidural.
When thinking about all the choices we have during labor and birth it is important to know the risks associated with medical interventions so that one can confidently make the best and most informed decision for themselves and their families. There is more research coming out that suggests that the routine use of this intervention, and really all medical interventions during childbirth, are not decreasing the risk of trouble, but actually increasing complications for both the mother and their babies. It is recognized by all major health organizations that medical interventions during childbirth should not be used unless deemed medically necessary. What we're learning is the risks of an epidural outweigh the benefits.
Risks include:
- Itching
- Fever
- Soreness
- Low blood pressure
- Difficulty breathing
- Difficulty urinating and catheter placement
- Severe headache
- Infection
- Epidural fever
- Fetal distress
- Low APGAR score
The good news is an Epidural is not the only option when it comes to pain management during labor.
The use of an Epidural, in most cases, interferes with our body's natural and instinctual abilities to cope with labor pain. Thankfully due to social media and the rise of natural/unmedicated childbirth there is more information available about what birth can and dare I say should look like. Our bodies know how to give birth and babies know how to be born. We can support this natural physiological process by using natural comfort measures and pain management techniques.
- Childbirth education
- Movement
- Massage
- Tens machine
- Hydrotherapy
- Breathing
- Prayer/affirmation
- Laughter
There is a beautiful symphony of hormones hard at work during a physiological birth. One type of hormones are beta-endorphins. These hormones are "natures painkillers." As with all hormones during labor we want them to be in balance and working with each other. High Beta-endorphin levels during birth can cause an altered state of consciousness which helps to move through the pain of contractions. This is the same hormone that causes a "runners high." Many studies report a severe drop in endorphin levels with use of epidural or opioid pain medication.
You can increase beta-endorphins by:
- Staying calm and comfortable
- Decrease disturbances, ask for quiet in the room (better yet include it in your birth plan), request no guests
- Avoid Epidural or opioid drugs
What about needing pain relief after induction?
If natural induction methods haven't worked and medical induction is necessary, say your water broke before contractions started or you’ve gone past the 42-week mark in most practices, something you can do that many people are not familiar with is requesting a Pitocin break. Many providers will offer an Epidural for pain relief before a Pitocin break. However, a Pitocin break can prevent uterine overstimulation and allow the drug to leave your system very fast. This provides almost immediate relief. Studies also show that stopping IV drip of Pitocin once active labor is achieved decreases uterine overstimulation, placental stress and fetal distress, resulting in better maternal and neonatal outcomes.
Childbirth as a rite of passage
I believe childbirth to be a necessary rite of passage into motherhood. Through the pain and tribulation that we face we ignite a lifelong connection with our child. That lasting feeling of "I gave birth to you." In addition, if we allow childbirth to unfold naturally, we have the opportunity to deepen our connection to God. This is the first of many challenges that we will experience as a mother and probably one the hardest. A full surrender into the hands of God, trusting that His plan is always greater and for good. This is a lifelong lesson that will be tested throughout our motherhood journey. The discomfort, pain and stretching that we experience as we are pregnant and also as our babies navigate through the birth canal is a literal expansion of our bodies but also a metaphorical expansion of who we are as people, how we identify ourselves and what our relationship with God looks like.
Ultimately, becoming a mother, changes us to the core, our very being. We go from navigating life as self to navigating as mother and child. This walk is a path to holiness. With that, I'd like to leave you with a question.
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