Epidural: Option or Not?

I follow a lot of different birth related pages on Facebook…go figure, right? Recently, one of the pages posted the question, “What do you wish you knew before giving birth?” The answers were varied and broad in topic, but one in particular stuck out. “I wish I had known that an epidural is not an option for everybody, there was apparently something wrong with my blood so I couldn’t have the epidural I was planning on. Ended up having a natural birth that I was unprepared for.”

I have had natural births, and for me-that is my preference for my birth experiences. I strongly believe that women’s bodies were made for this purpose and that childbirth is a normal natural process that rarely needs medical intervention. HOWEVER-that’s not what everybody wants (hooray for options!). Women need to have options in birth…but they need to be informed on their options. I’ve met countless women who were never told that they didn’t have to have an epidural (it’s not a requirement when giving birth!), women who were told “when you get your epidural,” rather than “if you want an epidural,” or “if you get an epidural.” If that is how we are going to talk to pregnant women, as if epidural is the ONLY option for them, then we NEED to make sure they know all the ins and outs of getting an epidural!

My heart aches for this poor mama who was relying on pain relief that then wasn’t available to her, and of course this wasn’t discovered until labor had already started and she was in the hospital! Labor pain can be made manageable without the use of medications, but it’s a lot easier to do when you and your support people are prepared and educated on what provides natural pain relief. How did this upset affect her birth experience? My guess, based off of what she wrote, was that it did affect her experience negatively. A friend of mine went through a similar but different experience. She planned on an epidural and everything was fine with her bloodwork, but it took so long for the anesthesiologist to get to her that she was pushing before they arrived…..2 hours later. She told me that had she known she would have to have a natural birth she would have been able to prepare, and it wouldn’t have been as bad an experience.

These two reasons are why I tell ALL of my clients and students that even if they decide they want an epidural, they should learn some non-medical comfort measures as well.

1.) How are you going to cope with labor pain BEFORE you get the epidural? Before you get to the hospital? The local hospital here does not admit women until they are 6cm (or if your water is broken, you are having a c-section, or if you are getting induced). 6cm is active labor, the second phase of *The First Stage of Labor* not the most intense phase (transition) but also not the mildest phase (early labor). Early labor also happens to usually be the longest phase of labor, so if you have to do the longest phase on your own (plus your spouse and other support people) how are you going to cope? Comfort measures!!

Okay….so you’ve made it to the hospital and you hang out in triage for what seems like forever, you FINALLY get into a room (hooray!) only to be told that the anesthesiologist is busy (surgery sometimes, other patients who were first in line…maybe came in further along than you-even though you may progress quicker, who knows!). You know you are getting an epidural, but how do you cope with the labor pain until you can get it? Comfort measures!

2.) You are one of the (un)lucky few who’s bloodwork doesn’t have good enough results to receive the epidural (they test your platelets after you request an epidural, ask your provider why and what they are looking for), your spinal anatomy doesn’t allow for safe administration of the epidural catheter, or you get the epidural but it only provides partial or no pain relief.

Now the first two instances are rarer, but they do happen. Unfortunately, many women don’t discover that they aren’t a good candidate for the anesthesia until they are in labor…already experience labor pains, already wanting that pain relief. The third scenario happens to 1 in 8 women who receive this type of anesthesia. Now some “hot spots” or ineffective epidurals can be corrected but not all, and even the ones that do can take time-time where you still feel most or all of your contractions. In these instances, you still have the pain but you lose your mobility due to the drugs in the epidural, so you can’t move to cope with the pain.

For all the women in these situations, having a basic knowledge of comfort measures would help relieve some of the pain they experience. A “plan B” if you will. Many women who try for natural birth mention in their birth plan that if they decide they need pain relief they would prefer an epidural…why can’t women planning for an epidural put some comfort measures in their back pocket, just in case!

Penny Simkins is a brilliant childbirth educator (physical therapist, doula, trainer…just a birth rock star really!), and she gives an excellent talk about the difference between pain and suffering that can be found here: https://www.youtube.com/watch?v=rlj9ehB-hLc

Basically, she discusses how labor pain, while it hurts and it can be hard work to cope with-it does not have to become suffering. Comfort measures, respecting women’s choices, educating and empowering women to make informed choices, supporting women during labor-all of those things can prevent a woman’s labor pains from turning into suffering. Suffering comes when women are left to sit and be in pain, they aren’t being helped, listened to, supported, respected, they weren’t given the information to prepare or the education on their options, and they don’t know how to cope with the pain. That sounds terrible, but it’s the reality for many women receiving maternity care in America.

When we neglect to fully inform women about what getting an epidural truly entails, we are doing them a disservice. Yes, many women who get an epidural will not have these issues or any other side effects…but for the women who do, we failed them. We did not give them the tools to still have a positive birth experience. Birth plans change, all the time. Our society seems to think birth plans are reserved for those who only want natural birth, but birth plans are for anybody giving birth. They help you wade through your options so that you know what your Plan A is, your Plan B, and even your Plan C and so on if need be.

There are other interventions that go along with an epidural, all part of the standard procedure-but few of which are explained prior to (let alone during) their administration. Before an epidural can be given they will give you a fluid bolus (large quantity of fluids given at a rapid rate) through an IV, did you ask your provider why? They will take your temperature more frequently, you and your baby will be continuously monitored (contractions and heart rate), your blood pressure will be checked more frequently….make sure you ask the why behind these procedures too-true informed consent is knowing the why of all the extra procedures as well as the main procedure. Lastly, when receiving an epidural you also receive a urinary catheter. It is not uncommon for women to be shocked when this last procedure is brought up. It makes sense, you can’t get up to go pee, but a full bladder makes it harder for baby to move down….but why don’t we tell women that if they get an epidural they will also be getting a catheter? What about all the risks that go with that procedure?

I am so grateful to live in a day and age where we do have so many options for childbirth. Women can truly pick the options that they feel will give them the most satisfactory birth experience. That said, we need to make sure that they are being given ALL the information, that way they can prepare themselves if something in their plan needs to change. Both of the women above would have had better birth experiences if they had known ahead of time that an epidural might not be an option for them. They could have prepared for that possibility before they had to deal with that reality. Am I saying every woman needs to try for a natural birth, no-absolutely not! There are cases where an epidural is more beneficial than not, but as great as technology is-it’s not a perfect science…especially when applied to biology. Not every woman is the same, we are diverse and unique, what works best for some will not work for others. To depend on technology as a fail-safe is foolish, to preach it is dishonest. To use it when necessary and as intended is wise. To be educated on your options so that you can make those choices before and during labor, is even more wise!