Some say that the crunchy mamas of the world are crazy for not wanting an epidural during birth. Who wants to feel needless pain? (Not me!)
But for most of us, it’s not about the pain. It’s about avoiding the epidural side effects.
Nearly 60% of mamas get an epidural during birth. But I don’t think most women get the full story about the true side effects of this intervention.
Rather than positioning epidurals as just a harmless pain reliever, doctors need to educate their patients about the risks and rewards so they can make informed choices.
Please hear me: this post isn’t about judging or shaming moms who get epidurals. I requested one myself during my very long and painful first birth but it was too late to get it.
I understand why epidurals can be a real gift in labor, and I support any mom who feels she needs one or even medically may need one.
This post is about educating moms about the potential epidural side effects so they can make an empowered and informed choice. (They also can change her mind about it all mid-labor, like I did :))
I wanted to write this post because I’ve heard from many moms who didn’t realize what they were signing up for when they requested the epidural. This has to change! Here is the truth about epidural side effects.
Epidurals can create a need for other interventions
Probably one of the biggest issues with epidurals is that it can set of a chain of more interventions. This is such a common occurrence that there’s a catchy term for it… “Cascade of Interventions.”
By just choosing to get an epidural, you are also signing up for several other interventions like continuous fetal monitoring (boo!), an IV because fluids help reduce the chances of a blood pressure drop, frequent blood pressure monitoring, and in many cases, a catheter :(. All of these things can make it difficult to move around and labor effectively. In fact, many moms are confined to a bed on their backs, one of the worst positions to labor in because it narrows the pelvis.
Epidurals also interfere with the natural cascade of birth hormones. This is a cascade we want! An epidural blocks uterotonic hormones such as oxytocin which helps your uterus to contract, so labor may slow down. Because of this, epidural use triples your chances of receiving Pitocin.
Pitocin interferes with your body’s production of endorphins, these morphine-like helpers offset the pain of birth naturally. However, because Pitocin is synthetic and not regulated by your body and baby, many women experience intense and frequent contractions that don’t allow mom or baby time to rest. Without adequate rest between contractions, baby may not get enough oxygen and become distressed. Fetal distress can mean an emergency c-section.
Epidural side effects: C-section
Fact: Epidural anesthesia in first time mothers, in particular, is shown to increase the chances of having a cesarean birth.
Some epidural supporters say that c-section is correlated to epidural but not causative. They say that it’s actually small pelvises (cephalopelvic disproportion or CPD) that are the reason women have c-sections. But CPD and other pelvic anomalies are quite rare, so this argument doesn’t stand up.
While it’s difficult to determine if women get an epidural because their labor is not progressing or if women get an epidural first, and then labor progress slows, we do know that babies are more likely to be in a persistent occiput posterior position (POP) when the mom has epidural anesthesia. That means that baby is facing forward instead of facing back, which reduces the chances of spontaneous vaginal birth. In one study only 26 percent of first-time mothers and 57 percent of experienced mothers with persistent posterior babies experienced a spontaneous vaginal delivery. In addition, the epidural can produce side effects in the baby (fetal heart rate changes, for example) that necessitate a cesarean. The topic of epidurals and cesareans is a hot debate; at the very least, it has not been possible to prove that epidural analgesia is NOT associated with a higher risk of cesarean birth.
Epidural side effects: Longer labor
Epidural anesthesia lengthens the first stage of labor by about 30 minutes and the 2nd stage of labor (pushing) by as much as 2-3 hours (source). We’re talking three hours of pushing for the natural mama versus 5 to 6 hours of pushing for the epidural mama.
This may be because mom can’t feel how to best push effectively. It may also be because epidurals numb the pelvic muscles and the vagina, so the brain doesn’t get the message to send a super surge of oxytocin to get baby out.
Another factor could be that epidurals block adrenaline. While it may seem that blocking adrenaline, the “fight or flight” hormone, is a good thing to promote relaxation, in a natural labor adrenaline slowly increases over the course of labor in order to give a mother a huge energy boost to perform the hard work of pushing at the end of labor.
The higher risk of persistent occiput posterior positioning of the baby (as we mentioned above) can also make pushing long and difficult.
Many advocates of the combined spinal epidural, or walking epidural, argue that they are safe because they reduce the risk of instrumental birth over standard epidurals. However, they still double the risk of instrumental birth compared with natural birth.
And, in practice, the walking epidural usually equates to the stuck-in-bed epidural.
Epidural side effects for mom
There are a number of potential side effects for mom when using epidural anesthesia. Moms are at increased risk of instrumental birth and complications for instrumental birth, pelvic floor problems (such as anal, sexual, and urinary) and complications from infections and epidural abscess.
Epidural use also doubles mom’s risk of severe vaginal tears. Epidural side affects also include complications from accidental puncture of the spinal cord coverings and permanent nerve damage in rare instances. Some moms have a “spinal headache” or migraine that lasts for a few days to a few months after birth.
Epidurals can cause fever in mothers during labor too. One study reports that 19% of epidural users developed a fever while only 2.4% of non epidural users did. These babies are 2-6 times more likely to be weak, require resuscitation, have seizures in the newborn period, have poor tone, and have low APGAR scores. The higher the maternal fever, the higher the risk to the baby.
Epidural side effects for baby
Some studies have found that epidurals may compromise fetal heart rate and blood supply at birth due to the reduced blood pressure in mom. Infants who are exposed to epidurals are more likely to be evaluated and treated for sepsis and may have reduced immune system function.
Epidural side effects: Reduced incidence of breastfeeding
A surprising correlation has been found between epidural use and fewer breastfed babies according to several studies.
It’s important to note that the same number of moms attempted breastfeeding… they were just less likely to succeed. One study found that an epidural during birth was connected to women ending breastfeeding by the time their baby was 24 weeks old.
One reason for this reduction in successful breastfeeding relationships may be that epidural side effects include neurobehavioral abnormalities that tend to peak in the first few hours after birth, also the most important time for establishing breastfeeding. It may also be because epidurals block oxytoxin, the hormone that helps mom and baby bond and mom’s milk to come in.
Other reasons breastfeeding can be affected by epidurals are:
- Mom might delay the first nursing session out of fatigue because she doesn’t get the same rush of adrenaline and oxytocin that a woman birthing her baby naturally experiences.
- Given the increased risks with the epidural for babies, it’s possible the baby may have difficulty transitioning after birth, leading to more time on the infant warmer or in the NICU, away from the mother.
- The baby’s rooting and sucking reflex may be delayed or depressed, and some studies have speculated that there may be a localized effect of epidural anesthesia that dulls the sensation on the baby’s soft palate, which is critical for proper latch and suck.
Epidural side effects: Potential lack of satisfaction
Epidural moms may be singing right along with Mic Jagger regarding satisfaction.
Pain isn’t something to be avoided at all costs, and it’s useful in birth. Pain helps signal your brain to release more endorphins (for pain management) and oxytocin (to stimulate contractions). Pain also helps mom know which position is most effective to bring baby into the world, and it helps her know when and how to push.
Oxytocin can put mom into an “other worldly” state during birth. (I know that I was whacked out in my second birth!) In this state, women can relax and get tuned into their body. An epidural interferes with oxytocin so women are not able to enter this primal birth place and are more aware of pain and can be more fearful.
Natural birth doesn’t mean no pain management
A woman’s body produces it’s very own pain killer (endorphins) which are released in response to pain. Many women have great success managing pain through movement, water, self hypnosis, birth affirmations, etc. Many doctors don’t understand this. Many haven’t seen a natural birth, let alone experienced one, and they think that pain should be avoided at all costs.
In reality, lack of pain rarely plays into a mom’s satisfaction with her birth experience. Many women say that they understand why women choose drugs, because labor gets really hard, but that they are glad they went med free. Several studies have supported this too. Women who use no pain medication reported the most satisfaction with their birth.
Don’t get me wrong—Epidurals can sometimes be a big help
Just like almost everything in birth, epidurals aren’t a black or white issue. And they certainly aren’t a moral issue. I am not here to judge.
Some moms who’ve been in labor for a very long time, need an epidural to rest so that they can summon the energy to push. Some moms need one to get past debilitating fear.
Sometimes, when all other options are exhausted, an epidural can actually help a mom avoid a c-section, which is a very good thing. Epidurals can help to relax the pelvic area, which can help bring the baby down and out of mom.
The key is for mom to be educated about the epidural risks and rewards, and then make an informed and empowered choice for her and her baby.
How about you?
What did your doctor tell you about epidurals? Did you end up using one in birth?
- Shorter, E. (1991). Women’s bodies: A social history of women’s encounter with health, ill-health, and medicine. New Brunswick, N.J., U.S.A.: Transaction.