I Can’t Believe I’m Talking about Epidurals

I am hesitant to write about epidurals. Because, honestly, I don’t want to armchair quarterback anyone’s birth, or leave anyone feeling like I am looking down on them. So I want to be clear that I am not here to judge you, or your birth, or your birth attendant, or your hospital. I am not the birth judge. I am the parenting judge.

(Just kidding! I’m not the parenting judge, either. Except for myself, and I often come up lacking.)

Epidurals and Me

I didn’t use epidural anesthesia in either of my births. In fairness, my births were really short. With Hannah, I was in active labour for about 4 hours, and with Jacob it was more like 2.5 hours. I am defining ‘active labour’ as being unable to sit still or talk during contractions, and feeling the need to engage in measures like vocalizing, swaying and so on. My birth records state that Hannah’s labour was 1.5 hours and Jacob’s was 45 minutes, based on confirmed dilation. Either way you slice it, there may be people out there who spent days in labour who would kind of like to draw a mustache on my photo. Feel free, but keep in mind that I am not responsible for resulting damage to your monitor.

Given my own birth experiences, I was very interested to learn that here in British Columbia, we have one of the lowest epidural rates in Canada for vaginal births. Approximately 30% of BC women had epidurals in BC, compared to 69% in Quebec, 60% in Ontario, 50% in Alberta and 39% in Manitoba. I actually thought this might be a good thing – perhaps it indicates that we are doing a better job of supporting women through labour and honouring their wishes.

Anesthesiologists Raise the Epidural Alarm

On Twitter, Chad Skelton linked to an article in the Vancouver Sun with the headline “Women who want epidurals not getting them in B.C.: report”. You can read some of Chad’s thoughts on his blog. My summary of the article is that the British Columbia Anesthesiologists’ Society believes the disparity in epidural use is related not to women’s choices, but to a shortage of anesthesiologists. While the article states that we don’t know why epidural rates are lower here in my home province, it conjectures that 11,000 women are being denied pain relief based on the difference between BC rates and the national average.

Let me be clear. If women are asking for epidurals and being denied them, or being made to wait 4 hours, that is a problem. I am not here to say that epidurals, or the mothers who use them, are bad. However, I took issue with this article on several fronts. The anesthesiologists may be somewhat biased in their call for more anesthesiologists, for one thing. For another, there are no actual, concrete examples of women being denied epidurals. And finally, I felt the article did a fair bit of fear-mongering. For example, here is a quote from Dr. Roland Orfaly, executive director of the Anesthesiologists’ Society:

If you have an anesthesiologist dealing with a life-and-death surgery and the women needs an emergency C-section to save the baby and just by chance the surgery finishes as the C-section is needed you have a near miss…An hour earlier and the baby could have died.

More Information is Needed

We need to do everything we can to protect the health of mothers and babies. But I would prefer to hear about actual birth outcomes, rather than stories of what could have happened. We hear a lot of scary stories about birth in our culture. It’s true that birth can be scary. But it can also be miraculous and empowering. Many women, like me, find labour manageable with good support. So I take issue with articles like this one that paint birth as horrible, and suggest that women are being left to suffer in agony, without unbiased information to support that claim.

I had a back and forth with Chad about this, and we both came to the conclusion that more information is needed. But I think we still stand in different positions on birth. Chad took the pro-pain relief stance, stating that “[he] had a front-row seat and [he’s] pretty sure [labour] hurt — a lot”. And I took the stance that supporting women to have the birth they want is the most important thing, and that lower epidural rates are not necessarily a problem.

Factors Contributing to a Positive Birth Experience

Some research bears me out. In a review of 137 factors that affect women’s satisfaction with childbirth, 4 stood out: personal expectations, the amount of support from caregivers, the quality of the caregiver-patient relationship and involvement in decision making. These factors overrode age, socioeconomic status, ethnicity, childbirth preparation, the physical birth environment, pain, immobility, medical interventions and continuity of care. This comes from women evaluating their own childbirth experiences. So, epidural use alone does not indicate how most women feel about birth.

We know that women who have midwifery care, and women who use doulas, have lower epidural rates, as well as fewer C-sections and shorter labours. In my own high-risk labour with Hannah, having a midwife made a huge difference for me. She was an amazing advocate with the doctors and nurses, she helped me get into positions that I found comfortable and she helped me to avoid being strapped down to the bed with monitors. If I hadn’t had her, I don’t believe that I would have coped as well as I did. We had a good relationship, she provided me with quality support, she kept me informed and she listened to me. Like the study suggested, these things made all the difference for me. I feel very satisfied with my experience, overall, and I would wish the same thing for other women.

Supporting Women

My position is not that women should not use epidurals, or that women should avoid all interventions. Epidurals, C-sections and induction all have their place. My position, rather, is that women deserve support through their birth experience, from people that they trust, who honour their wishes. And so, instead of saying that we should increase epidural rates in BC, I think instead that we should talk to mothers and hear their experiences. We should track outcomes for mothers and babies. Then we should act on that information, to help make birth better, and safer, for everyone.

What do you think makes for a positive birth experience? How important is epidural availability to you in birth? And can you believe I’m talking about epidurals, either?

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    Comments

    1. You are brave!

      I chose not to have an epidural with my birth and I’m very happy with how everything turned out. My labor was about 16 hours but I had prepared ahead of time and planned on going-unmedicated. Like you mentioned, it was important to me to avoid interventions in the natural process as much as possible. They were available at our hospital where we delivered, but that’s about all I know about it since I didn’t get one.

      But-! I also attended the birth of one of my friend’s babies who did have an epidural. And she was just as happy with her experience. I think it’s important that epidurals be available to those who want them in a timely fashion, barring other super emergencies for the anesthesiologists. Just because I wanted to do it my own way doesn’t mean that getting an epidural is a bad thing for everybody. Even if epidurals increase the rate of intervention and therefore c-sections… well, I can’t decide that for someone else. That’s the risk they decide to take in compromise for less pain.

      My two cents.
      .-= the Grumbles’s last post ..hurry hurry hurry =-.

    2. I can’t help it, I flinched at Chad’s “I had a front-row seat” comment. Because I’m pretty sure he was second row at best, unless he was the one actually pushing out an infant. I’m sorry, it bothers me when men act as if there being there is on any level equal to the actual labor. Just like when doctors say they “delivered” a baby. No, you caught it. The woman pushing it out delivered it. Rant over.

      From my experience (3 unmedicated births, long and short) yeah it can hurt a lot. But that doesn’t mean the woman in pain wants an epidural or has all of the information on the effects and problems that can be caused by one. Instead of urging for a needle pusher at every birth, why not push for more informed, supported births. Then the women who want epidurals can have them, and the ones who don’t aren’t feeling bullied into getting one. (and yes, the bullying happens far too often)

      Without solid facts, their assumption is pure bias (and maybe a little fear that their job’s in danger).

      • Summer, you have just perfectly articulated all of my reactions, thoughts, and convictions. Thank you!

        I, too have had three unmedicated births of varying durations, and better labour support for women would be at the very top of my list. I wish that care providers at the hospital (because there are no doulas or midwives where I am) would not automatically default to the drugs and other interventions as the primary suggestions for assisting birthing women.
        .-= Joy´s last post ..This list’s for you… =-.

      • Love this comment! I am yet to give birth and not sure what my plan will be (not ruling anything out at this point), but I did a double take at reading that.
        .-= Janine´s last post ..Zebra Baby Romper, Betseyville & more on ideeli Today =-.

    3. Like you, I had 2 fairly short labours. Going in I really wanted to stay away from any sort of pain relief like an epidural but it my labour had gone on hours and hours and hours perhaps I would have changed my mind.

      What I was impressed with during both my childbirth experiences is the doctors and nurses helping me offered but didn’t push it over and over. I think I was asked once, maybe twice during each labour if I wanted anything and since I felt I could handle it I said no.

      Apparently during my second labour one of the nurses observing (and I vaguely remember there being quite an audience in my room but I was a little preoccupied :)) asked what I had for pain and was amazed when she was told nothing.

      Regardless, I think an article like that has no place unless there is some more solid research done…perhaps one done by a woman since as Summer mentioned no man can really judge how a woman in labour is feeling.
      .-= Carrie´s last post ..Review: Agoo Leghuggers =-.

    4. I won’t re-hash Joshua’s whole birth story here (though anyone who wants to read it can: http://countrybaby.wordpress.com/joshuas-birth-story/ ) but… 41.5 hours of labor. I had contractions every 1-3 minutes for most of it, and after 37 hrs I opted for the epidural, due to exhaustion, not necessarily for pain. I had wonderful labor support, from both family and nurses, and we did so much work together to manage labor. The decision for me to get an epidural was not a light one, and it’s scary to think that once I made that tough decision it might not have been available, because I was really fearful that I’d not be able to push him out and end up with a C-section if I couldn’t rest. So the idea of not being able to get one when I felt I really needed it was scary. But then, reading the article, it seems there’s no real data to suggest that women were being denied epidurals. I’d like to see an actual number of confirmed women who asked for an epidural and didn’t get one. It’s just not there, so I would venture to guess that there’s better labor support to help women achieve their goals.

      I know that once I asked for an epidural, if I wasn’t able to get it due to lack of anesthesiologists, I’d come out and complain about it, especially if I ended up with a C-section.
      .-= abbie´s last post ..Real Sustainable Food =-.

    5. Sorry, forgot to say that I’m very happy with my birth experience. I know that I went in educated and prepared, and did the best that I possibly could before getting the epidural. I really feel like my case was an example of when medical intervention was necessary for me to acheive my goal of a vaginal birth. I should mention that it wore off by the time I pushed, so it didn’t cause any complications there.

      Also… my epidural was delayed, because hospital policy was to put 1 bag of fluid IV into me before the epidural, and before that I had no IV. So it took the time to put in the IV and let the fluid go in, but to me that was the start of the process. If someone went in knowing they wanted an epidural, they would get the IV and then there would be no delay.
      .-= abbie´s last post ..Real Sustainable Food =-.

    6. I had one natural birth and one in which I used an epidural. I really wouldn’t change either of them. My first labor was long and hard so I was glad for the epidural. It did not wear off in time for me to push. I pushed for two and a half hours and had to be told to do so each time. I assumed this was all because of the epidural.

      My second birth was natural and still I never had the urge to push. Not once. I figured out when I was supposed to with some coaching from the nurses but never once felt the pressure I was told I would feel.

      In both instances I also did not seem to want to give up the placenta and had to be told to push. At least I learned that I couldn’t blame my epidural for the fact that I had no urge to push. I think I would have always felt badly if I hadn’t tried it the natural way.

    7. I don’t think this has anything to do with with being pro or anti epidurals. But I do think that the anaesthesiologists saying that there aren’t enough anaesthesiologists are probably a little, ahem, biased. If all you do is give people epidurals then, as an anaesthesiologist, you never get to see what a normal birth is like. So you have no idea whether those women would have liked an epidural or not.

      It also strikes me as an example of doctors instinctively want to medicalise the normal process of birth (which is quite understandable – it’s what they are trained to do). Like we couldn’t possibly squeeze out a baby without an anaethesiologist standing by with a big needle for us!
      .-= Cave Mother´s last post ..The Reality of Child Mortality =-.

    8. I attribute my 2 postive birth experiences to an educated, devoted partner who advocated for me when one of my labors ventured past 24 hours, practitioners who honored my wishes and taugh me positions and relaxation techniques to get me through active labor without epidurals, and a positive attitude and a trust in myself and my body. Labor is difficult and, for some women, scary. We need to have faith in ourselves, our bodies, our partners and our practitioners.
      .-= Earth Muffin´s last post ..One for one. Is that really so hard? =-.

    9. I had one medicated birth and one unmedicated. The medicated birth was – not surprisingly – my first baby. I was enduced at 41 weeks and the labour (as can be expected with being enduced) was very painful. My husband and I did not have the support of our doctor or nurses for that matter and the epidural was pushed on me because “epidural guy had another appointment – so now or never” basically. Welllll, I ended up with a spinal epidural, episiotomy, vaccum birth (since I was too frozen to push) – that I wasn’t happy with. My second baby was delivered with the assistance of two midwives and my labour was 2.5 hours. I think with the proper support and armed with a lot of knowledge on the birth process and natural birth I think we could reduce the number of epidurals used for vaginal births. What I kept telling myself (call it my mantra) my entire pregnancy is that women have been giving birth since the beginning of time….and that I can do it myself!

    10. Without adequate info in the article it’s not really possible to theorise or conjecture – there may be a huge number of confounding factors skewing the results. Anaesthesiologists will of course have a vested interest in recruiting more – how would you like to face the stress of being the only one on call in a busy hospital, having to make decisions on who you help or not? or having to sprint from high needs to needs case, upping your adrenaline levels with every step? Having a bigger pool on duty/on call makes their jobs easier – I can’t see the correlation between more of them necessarily equating to an overabundance of epidurals, maybe a more timely delivery of anaesthesia-related services delivered by a more efficient, well-rested medic.
      However, adequate support for every woman labouring is a worthy goal, and I’ll just leave it at that.

      Personally, I’ve had one delivery of my own (countless as a bystander for other species!!) and I went the induction/epidural/c-section cautious route – cautious because there were extremely odd medical indications that Something Abnormal Was Afoot (me, not the Wee Guy). The birth went well, I have very happy memories, I was amazed at how painful (back labour, Wee Guy presenting face-first) and yet how non-painful the process was (awesome self/body/doula – thank you very much) and thanks to my iv/epidural combo I was conscious during the c-section and therefore able to ‘be present’ for the Wee Guy from his first few moments in this world. In hindsight I am very thankful for an epidural as I would not have been in such a capable state for Everything That Happened Afterwards (Wee Guy, not me). I would hope that every woman has the ability to make the choices I was able to make during delivery, and have them delivered in a timely manner so she can look back positively on the birth.
      .-= pomomama aka ebbandflo´s last post ..friday forte: little words and short sentences =-.

      • I should be clear – I don’t fault the anesthesiologists for wanting to recruit more. And I don’t doubt that they see things that would horrify me, or that they have the very best interests of their patients at heart. Not at all. And I wouldn’t categorize them as ‘drug pushers’ either. As I understand it they only show up after a mother has requested the epi. If we really do have a shortage of anesthesiologists, then we ought to address that.

        My concern is that they’re using incomplete data, and some fear-mongering, to make their point. Any of us will naturally see things from our own viewpoint, and not necessarily the whole picture. I bet that L&D nurses would have their own perspective, and OBs, and midwives, and every labouring mother, and so on. We need to consider the whole picture, and not just one part of the story. And we need to keep the actual needs and desires of the patients at the forefront.

    11. Melodie Towers says:

      Me neither. This sounds like a must read. Off I go to read it!

    12. Why is epidural such an evil after all? In general, I’m not sure I can see any point in feeling great pain, unless – of course – that pain works as an alarm bell symptom to indicate illness. Don’t most of us take a pain killer when we have a bad headache? But to be honest, I’ve never thought too much about the controversy around epidurals, as I never had any medication available during labors in the first place, including the forceps delivery of my first stillborn baby after hours of (induced) labor.
      .-= Francesca´s last post ..Friday’s flowers ~ commemoration bouquet =-.

      • Because A)there are many harmful effects of an epidural that most women are not told, or glossed over, B) there are 1000 different ways to not feel pain that do not involve potentially dangerous medications. Pain during labor is not “great pain” when properly managed for most, in fact many have pain-free or limited-pain and medication-free births. The controversy is that doctors act as if epidurals are sunshine and roses, without explaining all the harmful (and sometimes deadly) side effects that come from them.

      • I do not take painkillers when I have a headache (but i just might be a freak) and the problem is that women are not being properly informed or supportive in their birth experience. Epidurals alter the birth experience and this needs to be acknowledged rather than glossed over by the, “you don’t need to feel pain honey”. Once a woman is given an epidural she loses the ability to move around which is an important factor in helping the baby move through the birthing canal. Many moms have negative reactions on epidurals and you can’t undo it.

        This being said, I am not anti-epidural at all! What I am concerned about it the lack of awareness, information and proper consent. Also, if you happen to attend births you know that the average language used by hospital staff to women is demeaning and thoughtless. This issue is way past why would a woman want a natural (ie painful) birth over an epidural.

        (And yes Amber, I can’t believe you are talking about epidurals ;P )
        .-= Hillary´s last post ..hillaryboucher: We’re going to do it. Netflix sent us Avatar and this will be our virgin showing. I hope it lives up to the hype. =-.

      • Short answer: because epidurals are often the gateway intervention that can result in labour slowing down, ineffective pushing, fetal distress, forceps or caesarian delivery, drugged baby who has trouble breathing, time in the NICU, mom doing the marathon of newborn care while recovering from major abdominal surgery, disturbance in the important bonding time right after birth, significant trouble breastfeeding leading to breastfeeding failure (and the major psychological and physiological damage that gets done when that happens, to both mom and baby), weeks and weeks of excruciating spinal headaches for mom, and of course the risks that come with the epi itself, spinal damage etc.

        I chose unmedicated childbirth for the convenience and safety of me and my baby. You take a painkiller for a headache because the risk is usually insignificant. Acetaminophen is to a headache as epidural is to labour is not a good analogy.
        .-= Kirsten´s last post ..Work continues apace =-.

    13. My first birth I was edging toward not getting an epidural, but then I ended up with super intense leg contractions that came ever 2 – 3 minutes, lasted over a minute, and had stalled at being 8 cm dilated for a couple of hours. I decided I couldn’t take it, so asked for an epidural. Unfortunately (or fortunately, depending on your perspective) the anesthesiologist was busy, and stayed busy for several hours. I was given nitrous oxide and that helped a bit. Then finally I was 10 cm dilated and ready to push…just as the anesthesiologist was coming available. They told me if I waited 10 minutes I could get an epidural. I said I’d try without. “Are you sure?” said the nurse. “Yup.” Lucky for me I had a pretty short active labour…less than 30 minutes. It was painful, yes, but I handled it. Would I have handled it as well if it had taken 3 hours? Probably not.

      And that’s the thing–if you knew whether it was going to be 30 minutes or three hours it would be so much easier to decide whether to go with the epidural or without. In my case it worked out okay, but I have other friends who wanted an epidural and didn’t get one (both had their kids during SARS when hospitals were stretched thin), and both had traumatic birth experiences.

      With my second child I still was mildly curious about what it would be like to have an epidural, but decided to go without since I knew it had worked out for me the first time. That time labour was even shorted, but also more intense. I’m still glad I made the choice I did, though.

      I agree with you. The article needs to have more info about whether women who wanted to get an epidural were not able to get one, and whether they wish they would have been able to get one.
      .-= Mary Lynn´s last post ..Dance addendum =-.

    14. Baby #1 ALL NATURAL. Because it was my firts and I was nervous, I wanted a medical doctor to deliver in a hospital. And I am glad I did as it was way scarier and more painful and LONG than I imagined, and the bustle of nurses telling me I was doing great was exactly what I needed. But afterwards I regretted some of my natural choices. I sprained my shoulder pushing on the crouch bar (not discovered until much later), I damaged my bladder when my son’s head blocked the urethra early on… I tinkled when I laughed, coughed, jumped,etc for ages. I tore quite badly, and the length and intensity of the pushing lead to bad bruising on me and my baby (he was jaundiced as a result). And he was only 6 lbs 10 oz! It was not the impressive, gratifying experience I was hoping for with the birth of my child. Oh ya, and I got quite dehydrated and ended up getting a repiratory infection that the doctor blamed on my dehydrated state. It was messy. But I did get the honour of saying I did it NATURALLY. WooHoo.

      Baby #2. I had a WONDERFUL midwife! She was perfect at making my pregnancy comfortable emotionally and physically. Especially went I started pre-term labour and has forced on bed rest, she came to me and made sure I was comfortable and we both were healthy. She had tips and advice and strategies and resources that I did not have with my medical doctor. She also advocated natural birth, and I respect that, but after experience #1 taught me that at the very least I needed an IV for hydration. And a catheter may be a good idea too. BUT on the day of my EARLY labour we came on a hitch. On inspection we discovered the baby was breach (and sideways), and no amount of shoving would coax him around. I was told my widwife would not be allowed to deliver (but she could still be my coach — the BEST coach in the WORLD!), and I had to sign a release for a C-section.

      Now we come to the part that is relevent to your post. I signed the release. They hooked up the IV, the catheter, shaved and cleaned for the surgery, then we waited. and waited… and waited…… Meanwhile my labour progressed, the intensity of the contractions increased (but I was less scared this time and the midwife was very helpful at focusing and redirecting my pain). FINALLY many hours later the anesthesioligist finally showed up. Finally I was wheeled into the surgery and told to roll-up for the eipdural needle, it was literally hovering over my back when I screamed “I HAVE TO PUSH!” and I meant it! The surgeon did a quick inspection and said “this babies coming now” and I was allowed to roll back onto my back with a nurse on each foot to P-U-S-H. It only took about 12 puhes and my second son came out BUM first. The doctor had to do a cut (much tidier than the tear), and the baby came out amazingly okay.

      The anesthesiologist waited TOO LONG to be any help whatsoever. It was a drug free delivery after all.
      I remember during labour being REALLY pissed off that I had signed the release and was left to keep feeling all the pain knowing I was going to have to go through surgery at the end of it. It felt like I was being punished twice! (of course it all worked for the best).

      The good news is this birth had me feeling VICTORIOUS! I was hydrated, no bladder damage and a healthy baby in my arms. No harm done.

      (but, what if the C-section really was necessary? what if the natural breech caused the neck damage that they were afraid of, or the head got stuck and he suffocated, or any of the other things they were worried about to make me sign for surgery?… the anesthesiologist would have been to blame) Thankfully the what-ifs are pointless in this case.
      .-= *pol´s last post ..Rhythm of Home =-.

    15. Oh a. My sis after 28 hours of labour was given an epidural with her first. She was able to nap and recover some strength for the final part of the labour! She thought it was the best thing EVER!

      (I am still not a fan of a needle in my spine — shiver)
      .-= *pol´s last post ..Rhythm of Home =-.

    16. This was very well written, thank you for this. I’ve had one unmedicated birth. I think most of my friends think I’m crazy for having done so… lol There seems to be this idea that no woman in her right mind would EVER want to go through labor without an epidural, and this attitude makes me cringe… and seems to be the same one that leads to people assuming that a low rate of epidurals means women are wanting them but not getting access. That seems an irresponsible assumption to make, without knowing more information. It seems someone needs to go ask those women about their birth experiences…
      .-= Marcy´s last post ..It’s a good thing he’s so darn adorable =-.

    17. Quick response – I had two epidurals and hated them both. I had to have the second one shut off so I could finish my labor. If I hadn’t done that, I’d have ended up with a second cesarean.

      Getting an epidural is NOT the same thing as taking Tylenol for a headache. Last I checked, Tylenol didn’t cause stalled labors leading to cesareans or unhealthy outcomes. It also didn’t get injected into your spine with a needle that nobody wants to see.

      I wish just ONE PERSON had told me “hey, you might not want to count on that epidural, so how about learning some other techniques for coping?” But nobody did. They just told me to sit tight until I could get the epi and everything would be fine. It wasn’t fine. Not either time.

      Making an informed decision about it is one thing – but I think many women would opt for a different method if they knew just how NOT fool-proof the epidural really is. It’s not a Tylenol. Far from it.

    18. I had the best and easiest labours and deliveries. I did have epidurals with both my babies, with my first, I was 8 cm and decided to go ahead and get it, the second I think I was 6 cm dilated. Both times the actual experience of getting the needle in my back SUCKED, and was the worst part of my birth experience, BUT the benefits – the no pain I felt after – woohoo! That made childbirth for me SO amazing and so easy. Seriously, I had the most fun delivering my babies. I know, who says that, right? My OB-GYN who I LOVE and have been going to since I was 17 was right there with me, the labour and delivery nurses were amazing, my room was as nice and as big as a hotel, and I ate well. The entire experience for me – except for when the epidural when in – was super pleasant. I think everyone should be allowed ot and given access to an epidural if they want. It truly helped me!
      .-= Loukia´s last post ..Happiness =-.

    19. The most gutting thing about epidurals for me was that I went all the way through labour (12 hours established including 2 hours of pushing) without one and then needed a spinal block because they had to pull my daughter out!! Jeez, did I wish at that point that I had opted for an epidural some 11 hours earlier!
      .-= Mel´s last post ..Thankful Friday: Really, there is not much that matters =-.

    20. My comment is in response to some of the comments — it is counterproductive to perpetuate the idea that epidural = c-section. I could have pushed for 8 days and not fit the baby out my pelvis. The c-section had nothing to do with the epidural, and it was a darned good thing I had the epidural, because after pushing like a champ (the nurses were very impressed) for 4.5 hours, I had to have a c-section and waiting to put in the epidural at that point would have been awful.
      Amber, you wrote this very sensitively — respecting others choices as you always do.
      .-= Emily R´s last post ..Scout =-.

      • While your case was different, it has been shown that a number of labors become stalled or slowed due to changes in blood pressure and sensation as a direct results of an epidural. It is counterproductive to perpetuate the idea that epidurals never cause c-sections, for many they do.

      • The epidural also keeps women pushing in the lithomy position (on their back), which shrinks the pelvis and makes it harder to fit any size baby through. One can never know if the epidural did or did not contribute to their cesarean. In my case, I’ve done it both ways, and it was painfully obvious to me what the culprit was.

        If I had a dollar for everyone woman in my ICAN chapter who regretted that epidural…. I’m just saying, it needs to be approached with 100% fully informed consent. Most of the things that go wrong in labor occur after unnecessary interventions, yet birth itself usually gets the blame. It’s important for women to be aware of the difference in order to make the best decision for themselves.

        And kudos to Amber for bringing up this issue.
        .-= TheFeministBreeder´s last post ..And Maybe I Could Be a Better Hostess… =-.

        • Like many others I planned and prepared extensively to go natural and the decision to get an epidural was not taken lightly. In my case, however, it actually was the solution where usually it can be a problem. My baby’s heart-rate had shot up to 190 and my blood pressure right along with it. I had been in active labor for 11 hours and toughed it out 3 hours past when I would have *liked* the epidural. Those 3 hours involved back-to-back contractions while forced to lie on my back in the bed so the fetal heart monitor would keep working. This, to me, was still better than an internal scalp monitor, so I complied but I finally asked for the epidural. I was vomiting non-stop with each contraction and found it unbearable to be confined to that bed after the IV was started and continuous monitoring began.

          The usual side effects of an epidural – lowering of Mom’s BP, slowing of baby’s HR, and slowing of labor. The first two were fantastic for us, as it got the hospital staff calmed down and I was left to labor to 10 centimeters in peace without them freaking about my BP and baby’s HR which came down to 160 (high but acceptable). We did have some slowing of labor, but I was given an amazing epidural which took away most of the pain but allowed me to feel every contraction, feel my legs, hobble to the bathroom (avoiding a catheter) and my doctor (family practice doctor, not an OB) allowed me to fully reach 10 cm and wait for the urge to push, despite it taking almost 9 more hours. I was able to feel the baby descend, push effectively, and the whole experience from that point on was very joyful – there were 10 women in my room during pushing, and I will always remember how supportive and excited they all were – eight of them hospital staff, plus my Mom and my doula. My doctor didn’t push me to get the baby out fast, actually asked me if I would mind going slowly, and as a result I had zero tearing and very little trauma to my perineum. I was truly grateful. My son was born beautiful, healthy, and very alert – crying as he came out.

          All that said, I know I had an extraordinarily good medical birth, and that without an amazing doctor, an anesthesiologist dedicated to the labour/delivery floor, and a much more humane attitude toward medical birth than most hospitals have, I would certainly not have ended up with such a great experience. I also had a fantastic doula who helped advocate for me and speak when I was literally speechless from pain and vomiting. What is so distressing for me is that instead of using best practices when having a medical birth, most docs and hospitals use the technology and science in a way that is not good for women. It can be wonderful when applied sparingly and judiciously as it was in my birth but sadly, most of the time, is not, and is harmful to women and babies and the birth process. My doctor had spent the entire night before I went into labour delivering a baby, and yet did not flinch or rush me through my birth the following night even though she was certainly exhausted and wishing she was at home in bed. I’m sure part of the reason she also didn’t push for c-section is that she doesn’t do them, and was primed to give me a vaginal birth over just opting for a c-section. The hospital where I gave birth also supports midwives delivering in-hospital, so I know they are probably less surgery-minded than most, although an OB was on call and even examined me at one point during my labour – and would have been the one to perform a c-section if it had been called for and consented to.

          • I should add that at no time was the epidural pushed on me by the hospital, or by my doctor – although it was offered when I first arrived.

            Also, it’s quite possible my labour would have stalled had I not been 6 cm when I did get it – my contractions were very far apart and not as strong by the time I began pushing. So I am glad I held out as long as possible before having it placed, although it was unreal trying to sit still during insertion. I’m also aware that a lot of women don’t have epidurals that work as well as mine did, or allow them to feel anything. The anesthesiologist spent quite a few minutes ultrasounding my spine to make sure it would be placed completely correctly. I was very lucky, no doubt about it.

      • Same here. He was supposed to be 8 pounds and was nearly 10. I also didn’t progress far before I even had the epi and that was after three tries at induction (two gel treatments and Pitocin). The doctor could barely get him out via c-section and said that there was no way he was ever going to make it out vaginally, dialated or not. I have family history of trauma-style births (my dad and uncle both were complicated. One nearly died and one has a disabled arm as a result). My grandmother was a tiny chick like myself and she also had 10+lb babies. So we were glad we went epi, and ultimately glad for the emergency c-section too.

        All of these interventions have their places. Births like mine are the kind that you read about in books where women and babies commonly died in labor back when. So I’m grateful for any intervention that works! ;)

    21. Karen Edna Munro says:

      I'm not at all surprised to hear this. When I was in labour with my oldest, and stupidly had agreed to inducement so was in MEGA pain, I asked for an epidural and kept getting the brush off. Never did get that epidural, and they never gave me a reason why not… Probably lack of anaesthesiology guys.

    22. My first labour, I had an epidural although at the outset I did not want one. I was in a lot of pain and quite frankly did not know what the hell I was doing. I was scared and the nurse recommended it. I went for it and I truly believe my labour stalled because of it. It took oxytocin to get me fully dilated and my OB was almost ready to do a c-section. I do not regret getting the epidural and it was still a positive birth experience, I was just disappointed in myself that I gave up so easily. It was more about setting a goal and not seeing it through.

      With my second pregnancy, I really wanted to have a unmedicated birth, so I went the midwife route. I read books, mentally prepared myself and had long talks with my midwife to prepare myself. I was able to do it. Granted my active labour was shorter. But I think that if I had different support (not necessarily better, just different) in my first labour and knew I little bit more about what I was doing, my labour would have been shorter. The pain that I felt when things really got going in my second labour, is the pain I felt when I opted for the epidural in my first labour. I also gave birth in a shower stall with my second (my choice) and I am not sure they would have allowed it with my first.
      I think for a birth experience to be positive you need people around you that you can trust and who are going to help you make the best decisions that work for you and your labour.
      .-= Lisa´s last post ..Run Up for Down Syndrome =-.

    23. I nearly had an epidural after 39 hours of active labor (curse you, Amber — not really, I’m just jealous). I had transferred to the hospital for an epi followed by pitocin (the epi being to help manage the pitocin), per the midwives’ recommendation since I wasn’t visibly progressing (~5 cm). The anesthesiologist was delayed, and meanwhile the nurse-midwife at the hospital had figured out I had one small but tough ridge of tissue keeping me from dilating the rest of the way. She pushed it aside, and I was complete and ready to push. Just a moment after that, the anesthesiologist popped his head in, and we were able to wave him away.

      I’m so thankful he was delayed in my case.

      After 1.5 hours of pushing and 42 total hours in labor, my baby came out naturally.

      I used to always think I’d want an epidural, but I’m so glad I found ways to manage labor without one, and that at the last minute circumstances prevented me from taking it. I’d have missed (for me) the euphoria of pushing.

      I’m trying not to be competitive or judgy about epidural use. I’m thankful they exist for when they’re truly needed. I am a little dismayed that they’re so commonly prescribed without truly informed consent of the risks. Difficulty establishing breastfeeding is another one, perhaps because the baby tends to be sleepy. (http://www.internationalbreastfeedingjournal.com/content/1/1/24)

      But to the article: That quote you cited? I seriously thought it was a clueless commenter you were quoting at first. But it’s the director of the anesthesiologist society. He really does seem to be fear-mongering.
      .-= Lauren @ Hobo Mama´s last post ..The confusion of average vs. normal =-.

    24. Agh. Do I really want to see myself talk any more about this? I absolutely agree that if an epidural can be avoided it’s probably for the best. I had an epidural both times, but well after the point where most of my friends who didn’t have one had delivered (60-hour labour with Eve, not that she wasn’t worth it, most days). And that an epidural can probably be avoided in many cases with proper support and advocacy. And I wasn’t that crazy about having a needle in my spine either. But I was exhausted, and needed oxytocin. And yes, I do feel like a tiny bit of a failure for having done it. This is my big problem with many many things — I’m not adamantly anti-epidural, but I would have been happier if I could say I hadn’t had one. Just call me Mrs. Wishy-Washy. Once again, Amber — freakishly non-judgemental. How do you do it?
      .-= allison´s last post ..*****************Wordless Wednesdays: Take Me Out to the… =-.

    25. I had my say on my blog so I won’t rant at length here. But just a quick reply to Summer’s suggestion that — by saying I had a “front row seat” to my son’s birth — that I was in some way equating what I went through with what my wife went through. I wasn’t. Believe me.

      My only point was that I witnessed at close range how much pain she was in — and she told me, in no uncertain terms — which is why I feel so strongly that women should have pain relief when they want it.

      – Chad.
      .-= Chad Skelton´s last post ..Are women in delivery pain sometimes denied an epidural? =-.

      • Chad, you REALLY should have read (or taken) Birthing From Within, which specifically talks about how outsiders respond to a woman’s labor pains, and how they’d be a lot better off keeping their feelings out of her birth. Women NEED to feel the sensation of labor (which does NOT have to be painful, just ask any Hypnobirthing mother) to tell her body what to do. People see her working, and they think she needs to be rescued. Maybe she just needed better labor support.
        .-= TheFeministBreeder´s last post ..And Maybe I Could Be a Better Hostess… =-.

    26. I don’t have much to add, but just wanted to say that I think you did a stellar job on this and I enjoyed a couple laughs in the beginning too. Great writing!
      .-= Melodie´s last post ..Vegetarian Foodie Fridays: Lotus Land Linguine =-.

    27. Well done. Although I did have a difficult childbirth-one of those horror stories, I would agree that the woman should be supported in her choice of whether or not to use pain relief. I was talked into getting an epidural when I had been mentioning that I thought I might like to do it med free. I used an epidural, which wore off right at crunch time. I was amazed to find the pain was not completely unbearable. It was easier with my husband watching the monitor and telling me as the contractions were coming so that I expected them and breathed through. But I did end up needing a c-section so I guess it was a good thing I already had been hooked up.

    28. This is a great article Amber, I am glad you spoke about it.

      I totally agree that the most important factors in a positive birth experience have to do with the support the women receives. I had a fairly short, non-epidural birth, but I did not at all that it was a positive birth experience. It still upsets me to think about. It wasn’t that I wanted and epidural and didn’t get one, it was that I was made to sit in the waiting room for hours on end rather then getting care and support (and yes, I am getting a Midwife next time. They started covering Midwifes in Alberta 5 days after my daughter was born.) A women in labour should never to be told to take a number and wait and wait and wait, in my opinion.

      Sure, pain management has its place, but the number one thing we need is a better, more supportive health care system with better access to midwives and doulas.
      .-= kathleen´s last post ..ControverSunday: Discipline =-.

    29. I had epidurals and vaginal births for both my kids and I’m pleased with how the whole experience went. I mean, I’d be even more pleased if the babies could magically transport themselves out, but that’s probably a lot to ask for a birth experience. ;)

      Amber – as always, you are respectful of the difference circumstance surrounding each woman’s birth and experiences.
      .-= Lady M´s last post ..Raising Polite Little Hoodlums =-.

    30. Had an epidural, always planned for an epidural and nearly kissed the doctor on the lips when he was done! ;) I still had pain (lots in fact) and had to have a c-section for a number of reasons so if anyone thinks you get out of birth scot free, they haven’t recovered from a c-section! ;)

      Thanks for showing respect in your post to those of us who chose an epidural from an educated place. Mine came after hours of labor yet no progress (at all….like Pitocin by the gallons and nothing happened at 41+ weeks) so I was damned if I was going to sit there another 17 hours and pass out while my supposed 8-pound baby (he was actually almost 10 pounds) took his sweet time. Nope…raised my hand for that epidural and was glad I did. Still had a ton of pain, had an emergency C, complications from surgery and then c-section recovery. Had my share of pain despite the epi! ;)

      Epi or no, if people are educated about the choice either way, I say go for whatever is best for you!

    31. I was blessed to have two very short labours – 45 minutes of active labour for my first and about the same for my second. I was able to manage the pain just fine with the help of a doula and our midwife. I could have requested an epidural at the small midwife run hospital program we delivered at…but there might not have been an anesthesiologist there, and possibly would have to be called in and therefore, too late. Interventions for pain management certainly weren’t pushed or talked about, unless it as brought up by the labouring mother…and really, it was a midwife run program…those of us opting into this program went in with the idea of being medication free.

      I do believe that there is too much fear mongering when it comes to the reality of birth. From my own personal experience, it was amazingly beautiful and I would do it again a hundred times.
      .-= Heather´s last post ..Quiet Contemplation =-.

    32. Joan Morris says:

      Excellent thoughts. Both my daughters have had long difficult labours and very different experiences. You are right on about the support from people who honour their wishes. It makes all the difference!!

    33. I wanted a home birth but went to 42w and had to be induced in the hospital. Complications arose and they couldn’t find B’s heartbeat (and mine was low) so they did an emergency c-section…which of course means an epi. It was still a positive birth experience for me for many factors. A loving partner there by my side. A midwife who joked with me, held my hand when it got bad and who came to see us every day even though we were not under her care during our hospital stay. Most important though was the moment B was born and hearing his little cry and then seeing his face. I didn’t matter that we weren’t at home or that I had had a c-section.
      .-= Jen´s last post ..Think the oil spill doesn’t affect you…… =-.

    34. Hot topic for the win Amber!
      .-= harriet Fancott´s last post ..Ten Month Update =-.

    35. I think that birth is so different for everyone and even for every baby that there is not going to be just one set of ideals that make for a positive birth experience.

      Most people, even doctors and nurses, don’t fully understand just what an epidural can do during birth. It does not just relieve pain. Women should be completely informed of what an epidural can, can’t, and might do.

      But then, an epidural should be available to her if she chooses.

      With my first, I went through about 36 hours of labor with my first, broke down and got the epidural after many hours of Pitocin, endured maybe 12 more with the epidural and still had a c-section. I don’t care now if there were wrong choices made, and I am sure there were many, but I am glad to have had that epidural at that point. I was losing it and that is not what you need from a mama in labor…
      .-= Brenna´s last post ..The winner of the CamelBak Stainless Steel Kids Bottle from The Soft Landing… =-.

    36. I never wanted an epidural, but allowed myself to get scared at the hospital (which I can’t blame myself, I was pressured into being induced, and that was scary AND painful!). I didn’t have faith in my body and thought I wouldn’t last, which may have had some truth to it, as they kept cranking up the Pitocin. Anyway, the epidural made pushing SO DAMN DIFFICULT that I almost had a c-section. It also prevented me from listening to my body, which at one point was screaming at me to get up and walk around, and I couldn’t because of the epidural.

      The epidural certainly has a place, but I think women over-rely on it, and I think this is because they are scared and/or uninformed.

    37. I had both births of my children with epidural and I must say that sometimes I do regret the decision because ever since, I get very bad back pain and it gets so bad that I can barely walk. I know that they can offer you a blood patch as soon as possible after the epidural are finished but that I did not know off.

      Epidural is very nice to get if you opt for a birth without pain but it can have side effects as well.

    38. I was warned at Burnaby Gen that they might not have the dude available for an epi..C came so quick it was not needed.

      I find it alarming that BC Women’s is very quick to hand em out though again…the choice is ours..but again….I wish it almost wasn’t as I think they are the worse thing for labour and fear and lack of support make it way worse for women.

      I wish I had never even THOUGHT about one with Adam..it stalled labour…made things a nightmare …..and my doc was USELESS.

      I sort of gave up with Tara since I could see that nobody was going to deliver this breech baby and the midwife wasn’t saying much either…

      Again…regrets…

      I do think hospitals and OBs rely too much on them…..instead of focusing on midwifery and support programs for maternal care and education…..let more hospitals encourage water, hypnosis etc…even in rural hospitals..instead of money on medication and technology that is over and misused.
      .-= Crunchy Carpets´s last post ..Child Safety – FAIL! =-.

    39. I just noticed this posting in your what you learned in May posting. I am a near miss!! I real live NEAR MISS! There should absolutely be a full time anesthesiologist working/dedicated to maternity wards. 100%. I was in labour for 3 days..I was put on oxytocin…opted out of epi…cause we did weeks and weeks of hypnobirthing training..and pain was not an issue. Then things took a very bad turn for the worse….since my water was broken for so long I started getting a fever…and went from “we are watching it” to you are septic. (good times) I had to wait for a team to be pulled together….and epi at that point was not an option since I had that lovely blood infection putting something in your back can lead to a spinal infection. (pass). As soon as they were ready I was knocked out and the baby was taken out (unresponsive) and I lost a ton of blood. I would say that my husband had a first row seat to probably the most traumatic experience of his life…he almost lost both his wife and baby on the same night. The little one was over 41 weeks and because of the infection landed herself in the NICU for 5 days on antibiotics (nothing prepares you see an overdue baby in the NICU). I met my daughter about 5 hours after the surgery..but dont remember….I finally met her again 12 hours after giving birth. This was truly the most horrific experience…if the team was on hand at the time they were needed perhaps I could have had a better outcome…perhaps I would have been awake to see my baby after she was born…maybe my husband could have been in the room…maybe we could have done skin on skin..instead I sat there staring a clock waiting….

    40. Janice Williams says:

      I was denied an epidural (actually I had a c-section delayed and effectively denied) when I gave birth in July 2010 in Victoria due to a lack of anaesthesiologists. After discussions with other moms – I know more than a few who could not access the care they needed, when they needed. A healthy baby is one thing, but not the only thing that matters in a birth and being denied access to effective pain relief (or the treatment of choice between a woman and her doctor) is barbaric.

      • I’m sorry you had a negative birth experience. As I said in my blog post, I believe women deserve support through their birth experience, and to have their wishes honoured. It sounds like yours weren’t, and that sucks, quite frankly. I very much hope that everything worked out more or less OK in the end, and that you have a healthy baby today.

        Unfortunately, the article is no longer online, so this blog post makes less sense without that to refer to. I still maintain that we need to do actual research on birth outcomes and maternal satisfaction. Stories like yours are a good example of how we’re not serving mothers well, and hopefully more research would shine a light on that.

    41. This is an excellent post. Thank you for sharing. As a doula I often have prospective clients who are considering an epidural look at me with embarrassment in their eyes and ask, “Is it…I mean, will you…do you support/work with women who want to have pain medications?” and I always respond, “Of course! It’s your birth and your choice. My only goal is to make sure that you are as informed and supported as possible in making and carrying out your choices.” I always tell people that anyone, in any kind of birth scenario, with any kind of birth plan can benefit from having a doula. We’re not just here for homebirthing mamas! I’m glad that you included the link to evidence about self-reports re birth satisfaction factors. I have always found that data to be very compelling and it is so important to be able to back up our perspectives on birth with good, solid evidence. Thanks again!
      Heather Neville’s last post … With Our Own Two HandsMy Profile

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