To epidural or not to epidural

That is the question many pregnant women consider as they get close to their due date. For some women, it isn’t a question at all. They want it, and the sooner the better. For other women, an unmedicated childbirth experience is a really compelling goal. When I was pregnant with my first child, I thought I would absolutely have the epidural. Then my mom overheard me saying so, and that’s when I found out that she’d had three unmedicated births.

This was not something we had ever discussed. But realizing that my mom had been able to do it and hearing her many points in favor made me want to try it. We took a 12-week class in the Bradley Birth Method, since I liked the idea of my husband learning how to be a really integral part of the experience. By the time we finished that class, we had an airtight birth plan and a no-epidural attitude.

But then I went 19 days past my due date and things started to unravel. I’ll spare the details, but in the end I finally took the epidural, with both my mom and my husband cheering the anesthesiologist on. My daughter was healthy, and that’s what mattered most. My next two births, I went with a different doctor at a different hospital, and things progressed much more according to plan. I didn’t need the epidural. I’m not going to lie. Both of those were incredibly intense, painful experiences, but for me, the benefits of mobility during labor and the quick recovery time more than made up for the discomfort.

If you’re considering this question right now, here are a few things you should know.

• While there are some moms that fall very strongly on one side or the other of this question, the majority of moms agree that this is a personal decision you make based on your unique situation. Maybe you have a very high or low tolerance for pain. Maybe you have some other extenuating circumstances that make an epidural impossible (or absolutely necessary). What’s most important is making an informed decision, one way or another.
• If you think you want to try for an unmedicated birth (or even if you’re on the fence), take a class on the subject. You will get a lot of information and tools to help you along. You’ll get to practice relaxation techniques and your partner will learn some massage and pressure points. You’ll both feel ready and confident when the day comes.
• The best time to get an epidural is between 4-7 cm. If you get it too early, it can slow down your labor leading to additional interventions, and many hospitals won’t give it to you once you’ve reached the active phase, because things are moving too quickly at that point.
• In most situations, the epidural is perfectly safe for your baby. The drugs are injected locally, and a very negligible amount (if any) will cross the placenta. Some studies show that babies whose mothers have had epidurals have a more difficult time latching on to the breast, but this is not universally true.
• Epidural side effects can include a drop in blood pressure, headache, backache, itching, and shivering. Major complications are extremely rare. Occasionally an epidural will not work, or will only numb one side and not the other. But when everything goes just right, the relief is immense.
• Getting an epidural will almost always mean you’ll need to stay in bed for the remainder of your labor. This means that you cannot easily change positions, and you will need to push lying on your back. Sometimes this can lead to more interventions (like forceps, C-section and vacuum delivery), particularly if the baby is not positioned well and you can’t move around to try to get the baby to relocate. This happened to me in my first delivery – the baby was posterior (or “sunny side up” as my OB cheerfully put it), and I couldn’t do anything to fix it. We had to use forceps to get her out. Ouch.
• The benefits of un-medicated childbirth include an easier time pushing and a faster recovery. Also, the stress hormones produced by the body in response to the pain of labor are present in the placenta and umbilical cord, which may be evidence that these are useful in preparing the baby for life outside the womb.
• Whatever happens during your labor and delivery, stay focused on a good outcome (healthy mom, healthy baby) and be proud of what you’ve accomplished.

Big thanks to Raeanne Brazee from Boston Baby Beginnings for fact-checking this article and giving it her stamp of approval!

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