Epidurals

If you follow my blog or facebook page regularly, I think it is obvious that I think normal, natural childbirth is beautiful, amazing, and powerful. But the most important thing to me is that women have access to honest, accurate information so they are able to make informed decisions about their childbirth options. I will always support your right to make an informed choice across the whole spectrum from unassisted birth to a planned cesarean. Your body, your birth, your decision…. I just want you to have the opportunity to make conscious, informed decisions.

Sometimes, it seems like it is difficult for women to find accurate information on why many women choose to birth without the use of epidurals. And if you ARE choosing to birth with the use of an epidural, I think it’s important to understand the possible impact that can have on your birth so that you’re not taken by surprise.

There are many reasons for why women choose to avoid using analgesics during the birth process. One reason is that they wish to experience the normal process of birth, and know that although birth can come with intense physical sensations, it does not have to be the painful, miserable experience we often see portrayed in the media. I’ve been to births where there were varying degrees of the way the women experienced their birthing sensations, but which the women did not appear or describe as feeling as though they were “suffering”. Below is a great video describing the difference between pain and suffering:

To see footage of some positive, inspiring birth videos that look much different than anything you might have seen in films or on television, , check out my youtube channel. It might help you get excited about how different birth can look than from what we are bombarded with in poplar cuture! I’d also highly recommend watching Birth With Gloria Lemay. It’s my favorite birth dvd showing peaceful, gentle births. I have a copy I am happy to lend out to my clients or members of my free prenatal group.

Many women also choose to avoid using epidural analgesia during childbirth because they feel the risks outweigh the benefit of its analgesic effect.

Some of the risks of epidurals include:

• Drop in maternal blood pressure
• Maternal fever (which can lead to fetal tachycardia)
• Drop in fetal heart rate
• Slowing down of the birth process, leading to the use of artificial oxytocin
• Increased risk of a forceps or vacuum birth

Other, less common but very serious risks include nerve damage, infection,  or meningitis in the mother.

You can find more complete information in the BC Women’s Hospital Epidural Information Pamphlet.

Epidurals and Breastfeeding

According to Obstetric Guideline #4 of the British Columbia Perinatal Health Program, there is conflicting evidence about whether or not the use of epidurals can impact breastfeeding.

If you ARE considering the use of an epidural during your birthing time, there are a few things I’d like you to know based on my past experience with clients who’ve made this choice:

1. Your baby’s heart rate: As the Epidural Information pamphlet linked to above explains, sometimes your baby’s heart will often drop in the first 30 minutes after administering the epidural.

2. What pushing looks like: Spontaneous pushing, where you follow your body’s own urges and bear down only instinctively, is ideal. This is the type of pushing you will likely go over in your prenatal classes. It is less stressful for the mother, and more gentle on her body, reducing risks of tearing. Directed or forceful pushing, on the other hand, is associated with increased risks of “reduced oxygenation of the fetus, more frequent trauma to the birth canal, and potential injury to future pelvic floor function” (Albers et al).  Pushing with an epidural typically involves directed pushing, as you will not be guided as clearly by your body’s own sensations as you would in an unmedicated birth. It is much more difficult for your body to push effectively with an epidural.

You can find videos of both spontaneous pushing and suggestions for helping women push with an epidural in the “Educational” playlist on my YouTube channel.

3. Waiting for pressure, the urge to push, or “labouring down”: The Royal College of Midwives of the UK has a great paper on good practice guidelines for pushing. It includes the recommendation that pushing should not be encouraged until women experience some urge or sensation to push before beginning pushing, whether or not they are using epidural anaesthesia.  Although it is often common for medical professionals to encourage women to start pushing once they are fully dilated, pushing is much more effective if you wait until this pressure is felt, even if you have an epidural!

There are also other medications that are commonly used by women who want to take a pharmacological approach to birthing. These include nitronox (nitrous oxide mixed with oxygen gas), and narcotics (such as morphine and fentanyl). You can find more information on these options and their risks in the same Obstetric Guideline document I linked to above.

There are plenty of was to stay comfortable during birth that don’t involve the use of potent medications that have a variety of side effects and can affect the pushing phase. Doulas are a great resource for using natural methods of having a more comfortable and supported birth.

Jessica Austin: Childbirth Support & Information Vancouver, BC.