Wednesday, March 31, 2010


I have a theory about epidurals. I want to test it out.

But first, because this can be somewhat of a sensitive topic, I want to say upfront that I don't believe women who get epidurals are wimps or sissies or somehow not as tough as women who have drug-free births. I don't believe that women who don't get an epidural are necessarily incredibly tough or that they are weird pain junkies who love suffering.

I have given birth 5 times and each labor has been different. Some easier than others, some that were horribly painful. I have never had an epidural but that doesn't mean I didn't want one at various times! However between my desire to have drug-free births and my horror at the idea of a needle going into my spinal column, and other various factors, I've been able to avoid it. (Having a homebirth was the best way to avoid drugs, because they are simply not available. But that's another post.)

Okay, so here's what I've been pondering:

Why is labor such horrible suffering for many women that they feel like they need an epidural? I don't think it's because they're wimps. I think that their labors are not being supported in a way that helps them manage the pain and avoid drugs, and that these factors, more than the pain of labor, make women feel like they need an epidural.

For instance, if you have had an epidural in labor, how many of these other things were also true:

  • Your labor was augmented with Pitocin (i.e. you were induced or had drugs at some point to speed up your labor).
  • You did not have a doula or trained labor support person with you (NOT your husband or mother!)
  • You had an I.V. or fetal monitor on and had to lay in bed during labor - i.e. you were not able to walk around, squat, dance or in other ways MOVE.
  • You were not allowed to eat or drink in labor.
  • You felt uncomfortable/scared/bothered etc. by the number of strange people coming and going from your room, the bright lights, the sounds of other women screaming bloody murder, rude nurses/doctors, etc.
  • You did not have access to a bathtub, shower or birth tub.
  • You had to push while lying on your back.

I would imagine the majority of you would answer yes to quite a few of those! Most of all the Pitocin one. (I've had a Pit induced labor, ladies, and I know how it can feel! It is complete insanity, NOT the way a woman's body was made to labor, and personally I think it's cruel to give any woman Pitocin without also giving her an epidural at the same time. Letting labor follow it's own timeline without messing it up with drugs would be the #1 way to avoid an epidural!!)

So my point is that I think most of the women who end up with epidurals, especially those who originally wanted to avoid it or at least try to make it through labor without one, have these factors also involved. If you same women had

  • No Pitocin augmenting your labor
  • A trained doula or labor support person with you through your whole labor
  • Were not tied down to a bed with monitors and IV lines but able to move around freely
  • Encouraged to eat and drink throughout your labor to keep your strength up and stay well-hydrated
  • Had only people you knew and trusted with you during your labor and an calm, quiet, non-medical atmosphere (okay, this really only happens in out-of-hospital births, but the closer you can get to it in the hospital the better!)
  • Access to water to labor in, be it a tub, shower or birthtub, and
  • Were able to push in an upright or semi-upright position like squatting, hands-and-knees, side-lying etc.,

I betcha you would not have *needed* an epidural. Yes, you would still have had times of intense pain, but with a well-supported labor, like described above, the pain is manageable and all part of the work of giving birth! It is not suffering!!

I do want to mention here that I know in some cases women have well-supported labors that still don't go well and drag on for 24, 30, 36 hours and more. Sometimes babies are malopositioned or are very big and labor does not progress. Situations like these are not normal labor and they certainly call for the appropriate use of pain relieving drugs! This is when the normal, helpful pain of childbirth truly does turn into suffering, despite using all of the above methods.

One other factor that I didn't mention above because it's much more abstract but equally as powerful is FEAR. I think we have lost a sense of birth as being normal, natural, and doable and instead view it with terror as an emergency or something we need to be saved from. Fear increases the sensation of pain. So a woman who heads into labor terrified will most likely feel more pain than a woman who is calm and prepared, and therefore will probably feel the need for an epidural.

Lastly, if after reading this you're saying, "Yeah, but why are we even talking about avoiding epidurals? What's the big deal? Isn't pain relief GOOD? Why in the world would I want to feel pain during labor anyway?" I would point you to

Reported Side Effects of Epidurals
The Trade-Offs of Epidurals (excerpted from The Thinking Woman's Guide to a Better Birth by Henci Goer)

In short, we should want to avoid epidurals because they

  • slow labor
  • increase the use of Pitocin (oxytocin)
  • increase the likelihood of instrumental delivery (vacuum/forcepts) and cesarean delivery, especially in first-time mamas
  • cause complications, including life-threatening complications, even with experienced anesthetists and despite taking proper precautions
  • cause fevers, which increases the likelihood of a baby needing to be separated from the mother and subjected to diagnostic testing
  • may cause long-term and even chronic problems
  • "get" to the baby, making both mother and baby under the influence of drugs during their first hours together
  • cause profound disturbances in fetal heart rate
  • may have adverse effects on the newborn
among other things!

The value of labor pain is something I'll save for a later post. :)

I hope this hasn't come across as snarky or stuck-up. I am really interested in this and would love to hear from you about your thoughts. Improving birth is something I think is really important and I think that starts with women becoming educated and being supported through pregnancy, birth and postpartum!


Yvette said...

I fear epidurals. I cringe at the picture at the top of your post. It seems the desire to have natural, drug-free births (due to many of the reasons you listed) and the fear of a needle going into my already sensitive back (as I have scoliosis & times of back muscles spasms) has kept things natural the last two times. I really don't like labor though, so I'm excited to have a midwife this go-round for the support. Interesting post. I look forward to reading more.

melissa said...


Thanks for your input! I hope you find the support of a midwife to be helpful in getting through labor this time! I don't think anyone "likes" labor, but I know what you mean. The continual support and wisdom of a midwife through your whole labor can help so much to make the pain of labor manageable! I hope it goes well for you. :)

Rachel said...

Good post!

I did have an epidural and was planning on having a natural birth. I answered "no" to most of your questions. I labored in the tub for awhile, had a calm atmosphere with my husband, mom, dad and sister and only 1 nurse, was not given pitocin, felt that giving birth was a natural thing, etc etc, but I do wish I would have had a doula.

My water bag was at the opening of my cervix and wouldn't break, so for several hours my contractions weren't progressing anything. That, combined with the fact that Evan was positioned so his head would push down on one side, causing blinding nerve pain down both of my legs and terrible back labor, made me consider an epidural. I wasn't able to labor by walking around or actually even in any other position because of the type of pain I was experiencing. The only thing that alleviated the pain even slightly was my hubby on one side and my dad on the other pushing on my hips as hard as they could.

I was scared of getting an epidural and really didn't want one, for the reasons you cited. But, I am glad that I got one given the circumstances. For the next birth, Lord willing, I would plan to birth drug-free again, possibly with a birth coach.

Praise God I didn't have any side effects and gave birth to a healthy 9 lb 1 oz boy!

melissa said...

Rachel, thanks for sharing your experience! I think a malpositioned baby falls into the "abnormal" category and I'm glad that epidurals and other forms of pain relief are available for situations like yours. It sounds like you went into labor well-educated and with a great support team - labor is unpredictable and we never know how it will turn out!! Congratulations on birthing a big healthy boy. :) You did an amazing thing and that is quite an accomplishment!!

Sember said...

Melissa, I read this post a number of days ago. I seem to always be short on time. Perhaps you understand that? So, I am only now able to comment.

Anyways it has stuck with me. What stuck with me the most was your approach. It was so beautiful. I'm sure that most of us have a response to epidurals and many other things concerning becoming or being a mama. But I don't want to go there at the moment.

I believe that the pressures and judgments on moms are so immense these days. Yet, the need to be educated about things in a way that brings choices and freedom instead of condemnation is so important. Us moms need to be looking out for each other (something I believe has been lost over time as our lives become more and more fractured) with encouragement and love.

You have that balance and gift and I am so grateful for it. There are many times that I see these topics come up and cringe. But not with you.

You are lovely and I miss you. Love, Sember.

melissa said...

Sember, thank you! I really know where you're coming from - there is so much an attitude of competition and rivalry among mothers where there should be support and education! Natural childbirth/use of drugs or c-section, breastfeeding/bottlefeeding, homeschooling/classroom setting, organic/non-organic food... the list goes on!

But you're right, we have lost the communal support among women and families. We're not at each other's births anymore, saying "You are strong, I know you can do this!" That kind of support can make a difference in a difficult birth that otherwise ends in a c-section!

The #1 reason women site for quitting breastfeeding is "lack of support"!! Being there to support a new mom who's 4 weeks into an excruciating breastfeeding experience might be what it takes for her to push on and find that there's a beautiful breastfeeding relationship in store for her 6 weeks out. (I love La Leche League for that very reason!)

Can you tell I feel strongly about this?? ;-) Being informed IS important, but then we need to be supporting each other, helping each other towards difficult and beautiful goals.

I'm glad my post didn't come across to you as being judgmental - so often it can in sensitive topic like this. It's hard to write about at all, but was weighing enough on my mind that I took the chance.

It would be wonderful to talk to you about all this in person - I miss you too! Thanks for adding your thoughts, I know you are such a busy mama. :)