According to a 2018 Stanford University study, 71% of pregnant women receive an epidural or spinal anesthesia to cope with labor pains. This is an increase of 10% since 2008. What is causing this astounding increase of pain medication in labor? What do the women know who choose to forgo pain medication in delivery?
What is an epidural?
An epidural anesthesia is a local anesthesia that blocks the nerves in that region of the body and in doing so, gives the mother a total lack of feeling in her lower body. Epidural blocks often contain a concoction of an anesthetic agent (Lidocaine, Carbocaine, Marcaine) and narcotics (Demerol, Fentanyl, Morphine). They are given in the epidural space, which is a canal in the lower back that is surrounded by nerve roots and filled with cerebrospinal fluid. The average price of an epidural is $2,132.
The rise in popularity:
When listening to the conversation of birth in society today, fear is nearly always present. Whether it is a mother telling horror stories of her labor pains to other pregnant women in the name of “full disclosure” or women being uneducated about birth and clinging to the fear found in mystery. I think the common thought regarding an epidural in labor, is that it takes away all of the pains of childbirth and therefore the mother has a better experience – with these two things usually considered to be mutually exclusive. Pain is associated with bad, and no pain with good. In this era of instant gratification, why would anyone ever choose to be in pain and work harder than they have to?
Bonding:
There is no denying that pregnancy and birth is hard work. The very act of birth is the most noble thing a person can do – lay down their life that another might live. But many people forget, while the work that the mother is doing is obvious, the work that the baby is doing cannot be seen. They are working equally as hard, moving and turning and being squeezed by every contraction. There is a term used by sociologists called “social glue.” This social glue is the idea that shared pain brings people together. People are very commonly significantly bonded when they experience a high stress situation together, known as Unit Cohesion. There is no better example of this than natural childbirth. While hormones are also at work to help bond mother and baby, the experience of working hard together for a shared goal and sacrificing comfort and wellbeing to accomplish this goal creates a strong, immediate bond. When pain medication is introduced the mother is no longer feeling the work that her baby is doing. She is able to disengage from the process of birth and does not need to work as hard. This disengagement can also be seen in the transition into motherhood which can lead to postpartum depression, postpartum anxiety, and difficulties breastfeeding.
Epidurals in labor:
Epidurals are typically placed when the mother’s cervix is 4-5 cm dilated. Once it is given, the catheter will remain in your back and you will not be able to move from the bed. The loss of feeling in the legs makes it impossible to change positions, as well. Lying in one position can cause labor to slow or stop entirely, especially when that position does not use the help of gravity. This usually leads to the medical staff offering a drug (Pitocin) that will help to speed up labor by forcing the uterus to contract rhythmically. If results are not immediately seen, the Pitocin dose will be increased in normal intervals. The contractions that Pitocin creates are much stronger than normal contractions and although the mother cannot feel anything, her body is not getting as much of a break in between contractions as she usually would. This means that the baby does not get this break either. This can lead to fetal distress. Once fetal distress is present and the baby’s heart rate as dipped, the medical professionals will immediately begin discussing other options to get that baby out as quickly as possible. Depending on the situation this could mean the use of forceps, vacuum extraction, episiotomy, or cesarean section. With an epidural catheter already placed, it is easy to increase the medication and quickly have a cesarean section. This is known as the cascade of interventions – one almost always leads to another. This is why it is widely believed that epidural use can increase the risk of a cesarean section.
Epidural effects postpartum:
The most common statement from women who have had a birth with an epidural followed by a natural birth is, “The easy recovery from natural birth is worth the pain of labor.” This is because when an epidural is placed, the mother can no longer feel anything which most commonly leads to overexerting herself because she cannot feel when to stop and usually has a medication that causes her uterus to contract much more forcefully than it normally would. A mother with an epidural will have to work twice as hard to push, because she cannot feel her baby and is more likely to tear as a result. Therefore, a potential tear and a uterus that has been overworked usually leads to a postpartum hemorrhage and a much longer recovery period. Not to mention if the epidural leads to C-section, recovery from major abdominal surgery takes months. Many studies show that women with epidurals are more prone to struggle with breastfeeding. A 2005 study showed that as many as 17% of women who had gotten an epidural had quit breastfeeding by 6 weeks, compared to 5% who did not have an epidural. Some believe that this is due to the effects of the epidural on the baby in labor. The drugs that are administered can cross the placenta and many believe this leads to the child having a poor latch because they are lethargic from the narcotics. Others believe that the difficulties nursing come from a poor bond between mother and child, because she was emotionally removed from the experience of birth. The effects of the epidural on the baby are not often discussed. Fentanyl is commonly used for labor pain medication and is a drug that is up to 100 times more potent than morphine and is used in combination with heroin. When narcotics are used in labor, the child often has difficulty breathing or respiratory distress. They can also have no ability to regulate their body temperature which is vital for a newborn to be able to adapt to life outside the womb. Cold stress in a baby can be deadly. In addition, babies have been seen to have central nervous system depression and failure to thrive after having been exposed to narcotics inutero.
Final thoughts:
What a mother chooses to do with her birth is deeply personal choice that hopefully comes from a place of education and understanding, not from fear. While an epidural is usually a gateway to other interventions, the negative effects of the epidural alone on the wellbeing of the mother and baby are undeniable. While sometimes it may be deemed necessary to avoid further interventions, this usually only happens if the mother is a strong advocate for herself and knows her rights. There is so much mystery surrounding childbirth in society and an epidural is usually thought to be a magic potion to take away all the pain. However, an epidural is just prolonging a few hours of pain in labor for weeks of pain in recovery. No mother can give birth without doing the work that is needed. This will either be in labor and delivery or in postpartum.
Written by: Madeline Judd, CNA, BA, Midwifery Student