To Epidural Or Not To…

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Yesterday I read an article called The Truth About Epidurals by Melinda Wenner Moyer on the Washington Post Social Reader through Facebook and of course I can’t help but comment. If you haven’t read the article you can find it here.

The article itself appears to be this mothers justification of her choice and right to choose an epidural as pain management during her labor and delivery. Stuck between a rock; those who warn against epidurals, and a hard place; those who tout their safety, she seeks out scientific research to help in making the decision; to epidural or not to epidural.

As Moyer finds, scientific studies tend to be flawed and in this instance the inability to control the test group by either forcing or denying epidural anesthetics becomes an unethical dilemma and obstacle. The human condition and its instances such as birthing a child vary widely and as such conclusive yes or no answers are almost impossible to find. This is only the beginning of choices a mother will make for the health and well being of herself and her child and judging by Moyer’s article it seems as if she initially desired the comfort the epidural can bring to labor but was made to feel judged by that decision and thus proceeded to research.

When you are a first time mom you have no idea of what to expect. You have a whole host of choices to make with no previous experience to help make those decisions. Every aspect of labor and delivery is new to the first time mom from the very first pang of a contraction. Sometimes as I found out even the doctors do not know what they are doing.

April 1st 2009, the morning of my last in office pre-natal appointment with my ob/gyn I was pretty sure I was having contractions. After checking me my doctor told me there was no way I was in labor because my son’s head was still way too high. I had a feeling something was wrong and that she was wrong and we would find out four months later why his head never descended. I arrived at the hospital around 2am, now April 2nd at 5 centimeters dilated and at around 4am I received my epidural.

At the time I did not necessarily need the epidural as I was coping well with the pain but I had a feeling deep down that something was wrong and that my labor would end with a c-section. I liked the anaesthesiologist and figured since I was comfortable with him I would be better off getting it sooner than later after a shift change. Being heavily tattooed most people think I eat needles for breakfast. Not so. I am actually very afraid of needles. But I will say getting the epidural was relatively painless for having a giant needle put into my back and the pain of labor almost immediately disappeared.

Moyer goes on to dissect the reasons why some might take an anti-epidural stance. One such issue is that having the epidural impedes a woman’s ability to push the baby out and she goes on to say that “the women who had the epidurals were equally as able to lift their knees, wiggle their toes, and walk as those who had no additional meds.” Unfortunately this statement is a bit deceiving. What the anaesthesiologist insert into the epidural spinal cavity is lovingly referred to as a “walking epidural.” However by this point you are most likely hooked up to an IV as well as fetal and maternal monitors. This is not just an “argument” “proponents of natural childbirth might make” but standard hospital procedure you can expect.

After receiving my epidural I decided I was still going to be able to get up out of bed and go to the bathroom on my own. I unhooked my monitors. Grabbed my IV. Headed to the bathroom. And sat there unable to do or feel anything. The entire nursing staff came rushing into my room thinking something terrible had happened. I was told that although I had a “walking epidural” that I wasn’t actually allowed out of the bed. I was then given a catheter.

Moyer continues on to the theory that epidurals contribute to the rising rate of Cesarean sections being preformed in hospitals today. Here I believe that we are on the same page in thinking the problem is not necessarily rooted in the use of epidurals but in the rising rates of inductions taking place. Many women are not allowed to even get to “full term” let alone the point in which they naturally begin the labor process and quite frankly pitocin is nasty stuff. Doctors like to tell you it is no different than the bodies naturally producing oxytocin but this is a ridiculous fallacy. Induction methods all lead to pitocin. Which brings you to the epidural. Which in 50% of woman leads you straight into the operating room. Pitocin is derived from animal hormones. Is synthetic. And works to speed up your labor by creating unnaturally stronger and longer contractions.

The doctor arrived around 11 am on April 2nd to check my progress. At this point I was only 6 centimeter dilated. The epidural had effectively stopped my labor. She proceeded to break my water and began the pitocin. Towards the early evening I was receiving pitocin every 10 minutes or so at a dose which the machine needed an override to give. At around 9pm and 9 centimeters dilated the doctor decided to shut off the epidural.

As it turns out I happen to metabolize very, very quickly and in about 30 minutes I was not only experiencing the full pain of labor without the benefit of slowly and naturally progressing into such a state but I was pumped full of a drug which made it much, much more painful than any natural labor. I know this because my second son was born naturally, without any medication.

While commenting on a trial done in Mexico, Moyer writes that “unsurprisingly, 100 percent of the women who had no drugs described their labors as ‘very painful,’ compared with just 9 percent of the women with epidurals.” I think that the word Labor pretty much sums it up here. Labor is a hard, painful experience. It is an time in which you reach your breaking point and then push past it to see not only what your made of but to reach the other side. It hurts and it sucks. But when the moment finally comes to push that baby out it is the most amazing experience I think life can offer a woman. I wonder how many of those unmedicated women described their “very painful” labors with a smile on their face.

In both births where my unmedicated baby was able to nurse immediately and my highly medicated c-section baby had to wait upwards of 60-90 minutes before nursing both were able to establish healthy exclusive breastfeeding. There was a remarkable difference in my boys post delivery. My natural baby came out awake and alert. My c-section baby slept for 12 hours after delivery and I worried about whether I should have woken him up to nurse in that time.

What I appreciate about The Truth About Epidurals is that Moyer’s ultimate message is to research your options, decide what your goals are and what you are comfortable with and then make those important decisions. What disturbs me is what seems like a need to justify those choices to others and her use of lackluster science to do that. As you may already know science and I don’t mix well.

As a woman who has experienced both kinds of births I can say that I am neither for nor against the use of epidurals. Natural labor is the hardest work you could ever do in your life and the epidural was developed for a reason. There is no shame in using it or wanting it and no one should judge you for having it. But having had a natural birth and knowing what that feels like, I would love nothing more than for every woman to be able to have that experience if they want it. Often there are women who desire a natural birth but are either unprepared for one or in the case of my first delivery essentially laughed at. The statement Moyer’s makes that “anesthesiologists have published books about why women should embrace epidurals, arguing that they might even be beneficial because they reduce the baby’s exposure to labor-pain-induced stress hormones,” is to me the most bothersome part of the article. It not only sounds absurd but dangerous to perpetuate that notion.

Women have been birthing babies. Without medication. Naturally. For thousands of years. It is what we were made to do. To say that the epidural is more beneficial because it protects a baby from the mothers stress hormones is like saying genetically modified food is better for you because the chemicals kill the bugs that might otherwise destroy the crops.

For me I found more negative judgment placed on my lack of petition for an epidural and exacerbation at my choice to actually go through with a natural birth. Until, that is, it was over and I had done it. What we need to do as women is to make educated decisions and to support each other in those choices. If the pain is too much for you. Go ahead and get the epidural. If you don’t want the epidural. Don’t let anyone push you into having one. We are the lucky ones who get to choose. Who have the option. If you are preparing for the birth of your first child the best advice I can give is to talk to other moms. Those who have gone before you. As many as you can. Listen to their stories. Ask questions. There are many things within a birth which are typical or common practice and then there are the things you can never be prepared for like in our case craniosynostosis. But speaking with other moms with an open heart will better prepare you than any clinical trial or scientific study can.

In short I hope Moyer had the birth she dreamed of and that you and every woman gets to have the same.

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I am a food allergy mama of 4 boys, a former fashion designer, and a master of the five point palm exploding heart technique, keeping it Fantastico.

10 Comments

  1. Anonymous

    This a lovely response to the WP article. It is hard to find non-judgmental opinion pieces. No mother deserves to be judged for her birthing choices. No first-time birther knows or understands what will be happening to her. She always makes the best decision she can with the information she has. Always.

  2. Anonymous

    Someone commented on the WP article, essentially saying that she had 3 babies, two with epidurals, one without, and the one without came out the most sleepy and had the hardest time nursing. Her point was that the conclusions (based on fraught science) about cause and effect related to epidurals overlooks a key point: the individual natures of individual babies. I agree with that.

    I agree with you about the incredible experience of natural labor. I had my first that way — went into labor naturally, labored for 17 1/2 hours (did have a couple of doses of Stadol at about 12 & 14 hours in because, ow, and I couldn't relax). But was completely drug free when it came time to push. I didn't want the epidural that time because I really wanted to do it naturally and I didn't want to prolong the labor.

    I had to be induced with my second and, yes, that pitocin made the pain build more quickly than my body could adjust. I was just a few hours into labor, was only 4 1/2 cm dilated, and could not handle the pain — maybe for another hour, but not 5 more hours. But that's where the surprise came in. I had the epidural and 40 minutes later I was 10 cm dilated and pushed the baby out in 7 minutes. The same thing happened with my 3rd.

    Granted, it's anecdotal evidence, and a small sample at that, but I had two experiences with epidurals and both of them ran entirely counter to what the conventional wisdom on epidurals is. Perhaps the science simply cannot account for the individual physiological reactions of individual women, any more than it can account for the individual natures of the babies.

    All of that having been said, I wouldn't trade my natural delivery for anything. My husband was also really worried by my primal screams during that labor. But he was absolutely amazed that as soon as the baby was out, I was 100% back to myself. He describes it by saying "It was like flipping a switch. The baby came out and she [I] was back to normal!"

  3. Anonymous

    i thought your response to this article was so great! Thank you for making the point that as mothers, we need to band together, not rip eachother to shreds for making a decision about OUR birthing experience. I wholly agree with your opinions and appreciate your unbiased post! Thanks!

  4. Anonymous

    Yeah from the husbands perspective epidurals are up there with the greatest inventions. AC, cars, meat!! We have six and the one without an epidural was an in mitigated disaster. My wife was pure evil and to this day she says it haunts her. The other five were like a walk in the park.

  5. Dawn Seddio

    Thanks so much! I agree with you completely and try to attack my subject matter under the mind set that we are all struggling, all doing our best and all vulnerable and to support one another in all things is the best gift we can give each other.

  6. Dawn Seddio

    Thank you for sharing your experiences! There is just far too much gray area in our unique human composition to make any absolute scientific comclussions, for the most part, I think.

    It's interesting I wonder how many women have a natural birth, hold onto that accomplishment and then say, "Okay. I've done it. Now give me the epidural with the next," (excluding the pitocin factor) and I often wonder what I will do with my next and probably my last birth. Things that make you say Hmmmm…

  7. Dawn Seddio

    Thank you for a man's point of view. I love how you threw meat in there! I know for me I could not have had a natural birth with out the strength and support of my husband. Sometime's husbands get a bad wrap and sometimes you all are absolutely amazing! I hope one day your wife heals from that experience and it no longer haunts her!

  8. Anonymous

    I kept seeing people read that article on Facebook, but I don't use the Washington Post Social Reader; when I googled it, your blog came up. Well written, and I perfectly age with the sentiment: if you are an expectant mother, do your research. Then, when it comes time for labor, do what will make you feel the most secure and comfortable! Adrenaline is the enemy of oxytocin, so if you know that you don't even like getting flu shots and the thought of painful labor grips your already cramped internal organs with fear, for the love of God, go have an epidural! I had three natural childbirths, but the thought of being in a hospital where I can't have my privacy and keep unwanted nurses and monitors out of my space and off my body- yeah, I can feel that fight or flight response building just remembering the one time I toured a hospital before my second child was born (we'd moved when I was 7 months pregnant and our choices were limited; thankfully I found a free-standing birth center!).
    Women today have options our grandmothers didn't- educate yourself and stand up for yourself – or make sure you have a doula or strong partner at your side who will advocate for you!

  9. Dawn Seddio

    I definitely agree with the point you are making here about the intrusive hospital experience. This blog began with the telling of our natural birth. You can find that post here if your interested. Basically it took me three hours to go from 9 to 10 cms. Which I attribute to the hospital setting, the nurse and the monitors. Anytime anyone tells me they are interested in having a natural hospital birth I always stress the importance of having a strong support system on their side; preferable a woman, doula or midwife who has natural birthed herself. Hospitals around here expect you to have the epidural. But epidural or not it is most important to be empowered in your birth and not scarred by it.

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