Monday, February 22, 2010

Afterthoughts on Epidurals

Thanks to everyone who posted about their epidural experiences! If you haven't already shared yours, please do. I've really enjoyed reading all of your diverse perspectives. I'll probably have several posts discussing various issues raised in the comments sections.

Today, I wanted to talk about the not-so-empowering epidural experiences and what we can do (if anything) to prevent those from happening as often. Some women really wanted to give birth without an epidural but felt cornered, forced, or coerced into one. Or they had inadequate support from the nurses or their spouse and there were really no other options but the epidural for dealing with labor. Some were induced and--quite understandably--found the pain of Pitocin-induced contractions totally overwhelming. Some had epidurals that supplied inadequate pain relief or that left them with long-term side effects such as back pain or nerve damage. Some felt abandoned after their epidural, like they didn't matter anymore now that they were quietly contained by their medications. Some felt like they had caved in/given up too soon. And so on...

My question for you is: what are some practical things we can do, both individually and institutionally, to make these kinds of experiences less common? I'd like to hear from all of you: "lay" women, birth attendants, doulas, and childbirth educators. I know that we can't prevent every case of disappointment, dissatisfaction, or dis-empowerment. But surely there are things we could do to help. (And I feel that it will be a LOT more complex than simply telling women to adjust their expectations, or telling them that wanting a natural birth is a silly, selfish goal, etc.)


  1. My first thought is that the choice of doctor/midwife makes so much of a difference - whether the provider is going to push an epidural or be too eager to induce. That is easier said than done, especially with how common huge OB practices are. The mother may agree with some of the OBs but not like others - then it's just a matter of chance how will actually be there when that kind of decision is made. And once it is clear that the mother and OB have different philosophies, many women feel it's too late to switch.

  2. Quick thought on the ineffective epidural: for people to believe and act on the words of women who experience ineffective epidurals or break-through pain. Once someone gets an epidural, I am a big advocate for it being as effective as possible - otherwise you have all of the drawbacks and none of the advantages. But people need to listen to a woman who says "it's not working" and bring the anesthesiologist back ASAP. You can't always fix it, but why have her lie there not knowing if it could be fixed?? More than once when they went to check, the epidural catheter had actually pulled right out. That's not going to be doing any good!

  3. I think women (who are planning on epidurals) should be encouraged to prepare for a natural birth, in the event that an epidural does not work. Because the reality is, epidurals are imperfect. When they work, they are wonderful. When they don't and you are not prepared mentally to cope, it's awful. (I had 2 epidurals--one wonderful, one awful. Also had a natural birth.)

    I tell my friends now, 'Even if you are planning an epidural, check out hypnobabies or hypnobirthing. Get a doula, get support, have tools that will get you through if your epidural does not work.

    If you prepare for a natural birth, you at least have tools to cope no matter what the situation..and you might surprise yourself and forego the epidural. But I also tell friends, don't feel guilty if you choose an epidural. It does not make you less of a woman!

    just my thoughts from my experiences! ;) Suzanne

  4. I think the support of your partner is essential. When I was going through transition (I went from 4cm to fully dialated in 40 minutes!) I was crying to my OH that I wanted an epidural. He reminded me that I'd said that was the last thing I wanted and that if I had it I'd have to stay in hospital longer. I didnt want an epidural at all really I was just scared and not coping with the pain very well. As soon as I focused I was ok.

  5. I noticed that no one is talking about the effect of an epidural on the baby. Dr. Sarah Buckley has a great article pertaining to this:

    In my EFT (acupressure tapping) practice I have worked with many clients on clearing prenatal and birth trauma. Several have surfaced a feeling of "spaciness" or foggy thinking when we were focused on their birth experience.

    I surmise (and other perinatal psychologists would agree) that epidurals can have a lasting effect on the baby--possibly even into adulthood-- and we would be wise to research and consider the effects before choosing this option.

    Of course, I don't believe that these effects need to be permanent--or I wouldn't be working in the healing profession! I simply prefer prevention...

  6. I agree with Suzanne that every woman should prepare for a natural birth, even if they are planning to get an epidural so that you can cope if the epidural doesn't work or delay getting it until you've made more progress to minimize the potential negative side effects on progress, positioning, etc.

    Likewise, if you are planning a natural birth, even a homebirth where epidural is not available, you should be educated about epidurals (and all interventions) so that if you decide to get one at the hospital (or end up transferring to the hospital) in a long labor you can still be proactive with positioning and positive about your experience. I think if you are too committed in your mind about not using one, then you are more likely to feel badly about getting one if you end up needing one.

    Having the right birth team: supportive midwife/OB, doula, partner and nurses is the most important thing you can do to make birth a satisfying experience, even if it doesn't meet your pre-birth expectations.

    I had an unmedicated hospital VBAC using Hypnobabies (first birth was scheduled c-section for breech, no labor). It was awesome. The thought of an epidural never crossed my mind, but it was pretty quick and mostly pain-free, just intense with pressure towards the end. Besides Hypnobabies, I had a great doula and midwife who were there they whole time I was in the hospital (2.5 hours before birth) and very supportive nurses. It was pretty much an ideal hospital birth, but not all labors go that smoothly.

  7. As a doula and Lamaze educator, the first step isn't so much to find a midwife or OB who will be supportive, but to find a hospital (if you have the option) with the lowest epidural rate...or at least with a rate as close to 50% as possible. If a hospital has a rate in that range, then the nurses are usually really honest in their assessment of mom's need. Also, if a hospital has a really high epidural rate, chances are it;s because the staff has just gotten to the point where they would rather (due to staffing, lack of desire to spend time with mom, monitor @ station) have all patients on an epidural and in one place.
    The other part of the puzzle is to have a really good education. So many moms walk into my classes and think you can walk around and whatnot with an epidural. (In our area, you really can't get a walking epidural anymore.) Also, it's helpful to walk parents through the natural progress of labor, and they usually come to their own conclusion that you should try everything you can first and then move to the epidural if mom and all other options are exhausted.

  8. I have given birth three ways: by cesarean, vaginally and medicated, and vaginally completely unmedicated (in that order). My best birth (by far!) was the unmedicated birth.

  9. I think the best thing a woman can do for herself is to write a birth plan before choosing her doctor/midwife. You should choose your doctor/midwife based upon those who will support your birth plan.

    My doctor is very "natural" so it was a good fit in that he pushed me for as long as possible to not have an epidural until it was better that I have one.

  10. I think education is key, here. Both for the women and the professionals attending them. Epidurals have their place, certainly, but the reality is that they don't always work as expected and that they have a whole host of possible negative side-effects. As such, I think educating the women and the doctors in alternative methods of coping and dealing with the varied issues that arise during labor (pain, anxiety, fear, exhaustion, etc) would go a very long way to reducing the need for epidurals.

    I like what was said about making sure that when they ARE needed that mom continues to be listened to. I've seen that "epidural abandonment" and it's not fair or pretty. An epidural was never meant to take the place of support and care!

    Another thing I think is vitally important (though I'm not sure of all the ways to make it happen) is that society needs a mental face-lift when it comes to how we perceive birth in general. As a general rule, many women are entering labor almost wholly ignorant of how varied and grandiose the sensations of labor can be, both physically, and perhaps more importantly, mentally/emotionally. Obviously, nobody can really tell another woman what she is going to experience in labor but perhaps if more women entered it understanding the need for a lack of fear and a sense of "going with the flow" then tension and fear would not create the extreme sensations that drive women towards an epidural to start with. I think, as a society, we need to think of birth as an amazing process, not a scary ordeal. Women need to believe that they are strong, that they are doing something that millions upon millions of women have done competently and successfully before them. They need to be sure that the people surrounding them are completely confident in them!

    I think it's also extremely important for their support staff- be it their OB, their husband, the nurses, midwives, whoever- to be utterly aware that it's the MOTHER giving birth, not THEM delivering the baby. Mothers need to be supported in THEIR process, not encouraged to "let" anyone "take care of everything for them". Perhaps if we, as women, were encouraged to approach birth as something unique and sacred that we accomplish rather than survive, the attitudes we enter labor with would have a significant impact on how we handle labor. I really think we cannot possibly overestimate the importance of our psyche's on how we handle labor.

    There are so many other things that could potentially contribute to better experiences, the avoidance of epidurals or the appropriate care of women who have epidurals, too. I'm looking forward to reading the comments, here.

  11. In my one labor, I didn't have an epidural, so maybe I shouldn't be commenting, but I managed to make it without one with a 23-hour Pitocin induction with continuous monitoring and I wanted to pipe in (my first comment here) with the things that I think made the difference.

    First, I was very committed to not having one. I really, really wanted to keep my mobility. Obviously, women who are more open to having an epidural will approach the situation differently than I did. Also, I had planned to be at a free-standing birth center, and when I got induced, I felt like a lot of things got taken out of my hands. I think I held on to not getting an epidural as the one decision that truly was mine to make.

    Second, I had great support.

    It didn't start out that way. As you know, an issue that comes up in hospitals with continuous monitoring is that moving around tends to disturb the monitor. The overnight L&D nurse kept getting frustrated with me because the monitor would shift or the baby would move and it would look to her like there were some major decels going on. She would rush in, only to find that she needed to adjust the monitor. We were engaged in a bit of a power struggle over whether I could or couldn't move, could or couldn't get out of bed, etc. If it had continued like that (and for a lot of women in the hospital, it does), there's no way I would have made it.

    Fortunately, morning came, the shift changed, and my midwife and a new L&D nurse came on. When necessary, they took turns holding the monitor in place and moving it to make sure they had a good read on the baby and just encouraged me to do what I needed to do to be comfortable. They made the equipment work for me instead of making me make adjustments for the equipment. I think this made a huge difference.

    So I don't just mean that I had great moral support - though I also had great moral support! I had said that I would let them know if I wanted pain relief. When things seemed really stalled, my midwife did say she wanted me to think about having some pain relief because she was concerned about me getting too worn out. But when she said that, she also said I could use some IV pain relief to get some rest - that is, she offered options short of an epidural. And when I said that I would give it a little more time and see how I felt, she left it at that. And my husband just once said, "It's okay if you change your mind." But he let it drop at that. No one ever suggested that I wasn't coping well or couldn't do it or that there was no point in not getting one. If I had decided I wanted an epidural, it would have been my decision.

    Third, when I think back on my labor and birth, I'm not always sure that not getting the epidural was the "best" decision. I had a really hard time pushing effectively, which I tend to attribute to being so damn tired by the time I got around to pushing. And my son was worn out enough by the whole experience that, despite my not using any pharmaceutical pain relief, he was ... too sleepy to nurse. I've sometimes wondered if I had had an epidural if I would have had more energy and been able to push better. Reading the stories of women who felt the epidural made it really hard to push effectively makes me think there is just no way to know, but not getting the epidural does not guarantee effective, energetic pushing at the end of a long labor.

  12. I love this epidural series. And I really agree with Anonymous. Women need to prepare themselves for the possibility of a "natural" delivery even if they're planning on an epidural because (as I could have discovered the hard way because of my scoliosis) sometimes they don't work for everyone.

    (And thanks for the blog traffic on the play kitchen post.) :-)

  13. I have to agree with several of your other commenters that choice of provider makes a huge difference. With my first pregnancy I had a doctor who gave me pitocin, even though my water had broken and I was in active labor. My contractions completely changed and I begged for the epidural.

    The second time I had a midwife who supported my desire to (at least) try to have an unmedicated birth. She pretty much left me alone, let me labor in the bathroom and on my hands and knees. While it still hurt a lot, it never occurred to me to ask for an epidural.

    While I was more educated the second time around, I would by far pin the different experiences on my choice of provider. Go midwives!!!


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