Cold Spaghetti

Inspired by my a recent experience my friend Gwen had during an antenatal care visit, I decided to take a moment and reflect on epidurals.

Disclosure: I am an advocate of natural childbirth. I believe, have been told, and have seen that the natural process of labor and delivery can be a transformative experience where women may be surprised at the power and strength within themselves. This is not to say that a woman is better for having a natural labor or that women who try at a natural process and then decide to use drugs are failures. Women never fail in childbirth. My intention is just give some food for thought. And to begin to show how one intervention may easily lead to others – and ultimately, create emergencies and problems in an otherwise natural, perfectly normal, event. Birth is a miraculous, unpredictable process. Like nature itself, it challenges the rigor and boundaries loved by modern biomedicine. When we try to control it through medicine and machines, things can often go awry.

I believe that good maternity care means using science in support of this natural process, not in using science to manipulate controls over it. Sometimes, the best medicine is to use nothing at all. When you have a hammer, everything begins to look like a nail.

So, epidurals. Benefits: Labor is work, it is painful (the word is labor, not vacation). An epidural takes away pain but allows you to stay alert. An epidural can help a woman get needed rest or regain strength during a long and difficult labor.

But there are drawbacks and complications to consider.

— Epidurals require more intervention, which requires more intervention, which requires more intervention, and so on. Because of the risks involved with an epidural, additionally monitoring needs to take place: you must be hooked up to an electronic fetal monitor and an IV -– both of which carrying consequences within themselves. And having these interventions is strongly associated with additional interventions – see the next bullet, below. (Consider the reality of being hooked up to these large machines. Even if you did have enough feeling to walk, could you really experience a walking epidural? Not likely.)

— Pain signals your body and guides labor. Without that sensory experience (and with the combination of other factors) epidurals slow down, or prolong, labor. When this happens, women are often given synthetic oxytocin (called “Pitocin”) which causes stronger contractions. Use of oxytocin is (strongly) associated with higher rates of episiotomy, forceps, vacuum extraction, and cesarean sections – especially in first time mothers.

— With an epidural there is an increased risk of needing bladder catheterization (associated with UTIs). You are more likely to develop a fever because body temperature rises over time with use of epidural drugs. There is risk of excess fluid from the IV building up in your or the baby’s lungs.

— The anesthetic given in an epidural is administered into spinal fluid (cerebrospinal fluid). However, it easily passes into your blood vessels, crosses the placenta, and into the baby’s bloodstream. (Consider the craziness of this… you’ve spent months keeping your child away from a myriad of beverages and stimulants… and now your provider is giving your baby lidocaine and/or narcotics? Maybe drinking coffee isn’t so bad after all!)

— Henci Goer notes that two complications that can occur with the injection and tubing, the needle going deeper into the spine and the catheter migrating inward, have been reported to occur in as many as 1 in 3,000 cases. (These complications are serious and may result in convulsions or even cardiac arrest.) Drugs causing this type of serious reaction in that small of a range are commonly pulled from the market or put in very restrictive use.

— Spinal and epidural headaches are serious pain.

— Do you really want to make early breastfeeding more difficult for both of you?

— Finally, consider the look. All hooked up to machines and in a bed… versus unfettered and managing her labor with a group of trained supporters.

The bottom line. Few women are given the support they need to be successful at natural childbirth. Further, women go into the birth experience with very different expectations of what constitutes good medical care. Perceptions don’t change overnight, even if they are informed by biased or incorrect sources. What is important to me is that women understand the full scope of complicated procedures that are seen as so commonplace. Maybe if we asked more questions about the care we receive, we will eventually be more informed patients who can better advocate for improved childbirth experiences.

Further reading: Henci Goer, Robbie Davis-Floyd, Ina May Gaskin, Pam England. Email me for reading suggestions!