Epidural: get one or not get one?

[JThimm88]

For some time now my husband and I have been discussing whether or not to get an epidural. Well, mostly he's just been listening to be debate back and forth with myself, lol, as it doesn't really affect him.

I'm wondering if any women out there 1) decided to go with an epidural and why, or 2) decided not to get one, why you chose not to, and what method of pain management you chose instead.

A friend of mine mentioned the Bradley method, but that's generally learned within a 12 week course (at least here it is), and I'm due in 5 and a half weeks, so that's out of the question it seems.

I just don't really know what other options are out there yet (we're discussing some of them in my birthing class next week, but I get the feeling it isn't going to be as informative as I'm looking for unfortunately).

Thanks!

[Guest]

I decided to go without epidural because my mother who is a midwife is against it. She believes that using any medical intervention in childbirth adds unnecessary risks to a natural phenomenon. Midwives are trained to assist in childbirth as a non-medical event.

I ended up having to get induced (pitocin) because they found protein in my urine. So, I went into hard labor immediately - without the gradual progression that is normal. I was fine without the epidural through 22 hours of induced labor pains by walking with my husband, breathing exercises, and watching an enjoyable movie. No, I didn't learn this from anybody. My mom wasn't there when I gave birth. I just did what helped. I ended up having a c-section, so I don't know how it would have been through delivery. I'm pretty sure I would have been ok, though. And anybody who knows me will tell you how big of a wimp I am.

A friend of mine went through labor and delivery at home in a special bathtub (water birth). She was completely fine - she said, yeah, it hurt, but after 9 months of carrying this baby with my back hurting, my leg hurting, etc., I was glad to go through that one final stretch to be done with all of it. She said it wasn't too bad.

Another friend of mine went through labor and delivery at the hospital and she said she regretted not having the epidural. She said she was sooo in pain that she wasn't able to enjoy holding the baby for the very first time. She had epidural on her second time and she said that was definitely better.

So, there's really no answer to this. It is completely up to you. There is a risk to having it, so it's completely up to you.

My mother will insist that you have a midwife instead of just an OB. They are better trained at non-medical pain management...

[MorningStar]

I've had 4 kids with no epidural or pain medication of any kind. My reasons were:

1. I had a spinal tap from heck when I was 14. They stuck me over and over for over 30 minutes and it started to hurt so bad, I was screaming. The doctor acted scared that they were about to paralyze me. I decided that no needles would be entering my spine ever again. Way too terrifying.

2. It can lead to complications and a c-section. It can affect your blood pressure, then they give you something to counteract that, then that can affect the baby's heartrate.

3. I read that IV drugs can suppress the baby's breathing and make it difficult to stay awake between contractions, then you wake up at the peak of the contraction.

I went to just regular childbirth class at the hospital, learned how to breathe, and I brought music to help me be calm. I sing between contractions up until transition (the really painful part). I used a birth ball and walked around to help me dilate and get things progressing faster.

Good luck with whatever you decide! Even if you get an epidural, it is smart to take a class. Sometimes it only works on one side or you have to wait a while until they will give it to you.

[sweetiepie]

Ok, Mother of 5 here, and I have had 2 natural, and 3 with an epidural.

Natural: I was lucky that my labors were short, (3-4 hours), it is very painful, but since they were short, I could handle it. It feels very empowering, womanly, and wonderful to have a natural birth where you can feel you and your baby working together to bring him into the world. To feel every push it takes to get him out.

Epidural: After natural the first two times, I decided to try the epidural. It was WONDERFUL. We could just talk, laugh, visit, and then time to push! Baby comes, everyone is relaxed, and I am rested for the most part.

I would say, try it natural at first. The more relaxed you are, the less painful it is, and ride those contractions like a wave (stay on top of it, and don't let it get ahead of you). Sorry if that doesn't make sense, but it will once you are in labor. It does hurt, a lot, but once you get to push, it is a good hurt kind of.

But if you are in serious pain, getting very tired, and they tell you are still like 3 or 4 centimeters, I wouldn't feel badly about needing an epidural. I have been to some of my friend's births, and I am amazed at how long it takes some of them, and I could never last that long in that kind of pain. But if you make it to 6 or 7 centimeters, 10 comes really fast, trust me.

So excited for you! Just see how it goes, keep your options open, and try to be in tune with your body, you just get to breathe and ride the wave!

[sweetiepie]

And sorry if some of these posts scare you, I hated it when women gave me scary stories! The last thing I needed right before I was going to have a baby! It will be fine.

[carlimac]

Two words...get one!

[MarginOfError]

Statistically speaking, the medical outcomes with an epidural are no different than the medical outcomes without the epidural. I've never come across anything that indicates that having an epidural increases your likelihood of a c-section. Even if it did, I don't know that I'd care since the medical outcomes following c-section are better than the medical outcomes following vaginal delivery.*

Anecdotally, what I've heard most often is that women who forego the epidural feel a lot of pain during the delivery, but not as much pain after. Women who use the epidural seem to report less pain during, but more after. I've not seen formal research to support this.

Not being a woman, I can't add much in the way of experience, but I can at least say that your choice to have an epidural generally has no effect on the health of the baby or mother in the long or short term. You can't really make a wrong choice when it comes to this.

* A vaginal delivery with no difficulties probably has very similar medical outcomes as a c-section, but when there is tearing; an episiotomy is required; or the use of forceps or a vacuum is required, the outcomes are significantly worse.

[Maureen]

I chose to not have an epidural when I had my kids. Although I wouldn't make a firm decision until you are actually in labour. You can't really predict how labour and delivery will go until it starts to happen. Once I saw that needle though in the beginning of my prenatal classes I made the decision to not have one. And I've learned that epidurals might have a small effect on respiratory function. For my first I was induced after not progressing well and it didn't take long before they gave me demerol. With my 2nd, I had natural child birth because I got to the hospital late and by then was fully dilated. Natural child birth can be pretty intense because there's nothing to take the edge off of the pain and weird discomfort; my water didn't break until my first push and the feeling of pressure from that was so uncomfortable. But recuperating is easier without drugs. Good luck!

M.

[Tarnished]

My baby came last Thursday, I chose to get an epidural. I had to be induced with Pitocin (which from what I have heard makes contractions more painful, I don't know if this is true since it was my first childbirth), right as the big transitional contractions started up my epi failed, it faded slowly away and then quit all together. I felt the entire childbirth as if I had chosen to go natural. It hurt, it hurt so much that I just wanted the baby out of me so that I could rest and not be in pain for a little bit. I don't know what caused my epi to fail, but when the doctor stitched me up from my episiotomy I could feel her needle even though she had used local anesthetic.

My advice, if you choose to go natural then take a class or something to prepare yourself for the pain and to have something for pain management. If you do choose the epi then I hear it is nice not to have felt the pain. Usually epidurals don't fail, they don't know why mine failed, I think it might have something to do with some of the back pain I have dealt with in my life. And this is back pain outside of being pregnant, I am guessing that my back is messed up in some way and this caused the epi not to work correctly. Will I get an epi next time? Probably, mostly in hopes that it will work and I won't feel anything. I will say, the pain of childbirth is pretty intense, it changes your whole perception of pain from that point forward.

[Gwen]

tarnished, congrats on the baby. i'm sorry your epi failed.

the pain you felt was probably far worse than if you had gone natural all the way. the delivery builds upon itself, it is a gradual pain, the body can cope with that. for you you missed all the build up due to the epi so you joined in progress at the most intensely painful part. you have my sympathy. don't let that experience put a negative cloud on the future.

jthimm, i've had 5; 4 with epi and 1 without. i would chose without again in a heartbeat. my first was the most positive experience with the epi. i didn't do any kind of birthing classes and was not prepared for the pain management aspect of it. my ob/gyn did his own epi's. he had knee surgery twice under an epi and one was good and one was bad so he knew exactly what the consequences were of screwing it up. he was awesome. the epi worked just like it was intended to. the second my doc was out of town and the hospital guy did it, i don't know what he did wrong but everything was numb except one softball sized spot right next to my groin. i felt everything right there. it was horrid. they didn't believe me that it "missed a spot" and so they gave me a booster of the meds. took forever to wear off, i couldn't get up to pee or anything for hours without help. that was my worst experience. the other 2 the epi seemed to work fine but looking back having had a child without i think there are things that would have gone better had i not gotten one.

baby 5 was a vastly different experience. it was a more self directed birth instead of doctor directed (with the epi the dr had to tell me when to push). the over all difficulty of the birth was significantly decreased, didn't push as long, the pushing was more effective, etc. the recovery was a million times easier. i don't know if i could have done it with my first. i needed the experience, the confidence in myself and an idea of how to approach the pain management. without really is an empowering experience.

to manage pain i used visualizations and breathing. i didn't do any classes i did what comes naturally to me for pain management. i would close my eyes, envision a circle (my cervix), take long slow breaths in and let them out. as i breathed out i envisioned the circle getting slowly bigger. when the pain was intense i would look at the ceiling and blow out. i'd envision the pain coming out in my breath, as i exhaled try to relax all the muscles, give it permission to leave. (i teach my kids this same method when they experience pain. it really is effective.) with any painful situation there is often a cycle. fear, tension, and pain. fear creates a tension in the body, tension increases the pain, more pain increases fear and it just gets worse. go in knowing it's going to hurt and you are strong enough to handle it, don't be afraid. practice good relaxation techniques to decrease the tension in your body, that will decrease the pain.

if you are going without i would suggest looking up some info on alternate positions (on your side or squatting is supposed to be very best) that will help with pain reduction. if you seriously want to research it message me and i can give you some sites that have a lot of info on med free child birth. just keep in mind a lot of those sites are adamantly against epi's and will be painted with that brush. but sometimes that's what it takes to make an informed decision. i think many women (including myself) don't/didn't do enough research to make a truly informed decision when it comes to child birth options and circumcision. that's what i would change, i might have still had the epi with some but i wish i had done more research with all of them.

in the end only you will know what is best for you and every woman and pregnancy is different. what you can handle with one may be vastly different than the next. as one nurse told me as i was deciding about an epi "the only way you aren't having a natural childbirth is if it comes out your nose".

i hope you have a positive experience. :)

[MorningStar]

My sister has scoliosis and it took the guy 7 tries with her epidural and then it only worked around her belly, but not her nether regions. He never had anything that difficult before. Another friend said it only worked on one half of her body. It's better not to assume that it's going to take your pain away.

MOE, I had a 2nd degree tear with my first child and didn't have to have an episiotomy. Doctor said the cut would have been worse. With my other three kids, I didn't tear at all, which was way nice. Women have told me stories about tearing exactly where they were cut before. Sometimes an episiotomy will cause a woman to tear the rest of the way. Ugh!

Oh, and I agree that it would be a lot harder to suddenly feel the pain of transition labor after no pain and pitocin makes your contractions stronger than necessary. I had an internal monitor with my first that measured the strength of the contractions. It went off the chart. Big difference not having it the other three times. I had one non-back labor and that was even better. I kept thinking, "Shouldn't this hurt more?"

[MarginOfError]

MOE, I had a 2nd degree tear with my first child and didn't have to have an episiotomy. Doctor said the cut would have been worse. With my other three kids, I didn't tear at all, which was way nice. Women have told me stories about tearing exactly where they were cut before. Sometimes an episiotomy will cause a woman to tear the rest of the way. Ugh!

All of this is true. The difference is that a clean cut is easier to repair than a tear, which may be the only reason we still do them.

[Guest]

Statistically speaking, the medical outcomes with an epidural are no different than the medical outcomes without the epidural. I've never come across anything that indicates that having an epidural increases your likelihood of a c-section. Even if it did, I don't know that I'd care since the medical outcomes following c-section are better than the medical outcomes following vaginal delivery.*

Anecdotally, what I've heard most often is that women who forego the epidural feel a lot of pain during the delivery, but not as much pain after. Women who use the epidural seem to report less pain during, but more after. I've not seen formal research to support this.

Not being a woman, I can't add much in the way of experience, but I can at least say that your choice to have an epidural generally has no effect on the health of the baby or mother in the long or short term. You can't really make a wrong choice when it comes to this.

* A vaginal delivery with no difficulties probably has very similar medical outcomes as a c-section, but when there is tearing; an episiotomy is required; or the use of forceps or a vacuum is required, the outcomes are significantly worse.

MOE, this is not correct information. A c-section is invasive surgery. An episiotomy is a wound. The c-section tears through your skin, muscle, and uterus - you have to move internal organs to get there. An episiotomy is a tear to the vaginal wall - which is similar to getting stitches for a surface knife wound.

A vaginal delivery without episiotomy is not even a medical event! You can have it in your kitchen and be on your merry way after the baby comes out!

My mother gave birth on Christmas Day, she was not going to spend her Christmas at the hospital - she gave birth and came home to enjoy Christmas Dinner. No medical intervention like epidurals or anything.

My sister-in-law gave birth on December 30. She was not going to spend New Year's Eve at the hospital - she gave birth in the afternoon, came home less than 24 hours later to enjoy New Year's Eve. All natural.

Both my mother and my sister-in-law will not be able to do that - AT ALL - with a c-section.

[MarginOfError]

MOE, this is not correct information. A c-section is invasive surgery. An episiotomy is a wound. The c-section tears through your skin, muscle, and uterus - you have to move internal organs to get there. An episiotomy is a tear to the vaginal wall - which is similar to getting stitches for a surface knife wound.

A vaginal delivery without episiotomy is not even a medical event! You can have it in your kitchen and be on your merry way after the baby comes out!

My mother gave birth on Christmas Day, she was not going to spend her Christmas at the hospital - she gave birth and came home to enjoy Christmas Dinner. No medical intervention like epidurals or anything.

My sister-in-law gave birth on December 30. She was not going to spend New Year's Eve at the hospital - she gave birth in the afternoon, came home less than 24 hours later to enjoy New Year's Eve. All natural.

Both my mother and my sister-in-law will not be able to do that - AT ALL - with a c-section.

I'm not sure which part of my statement you are claiming is incorrect. So if you could clarify what you think was incorrect about my statement I'd be happy to respond.

In the meantime, an episiotomy is a bit more than a wound. It's a surgical incision. (See the wiki-God) In the US, it's done when the physician feels that tearing is imminent, and is done because it's easier to repair than a tear.

[NeuroTypical]

My baby came last Thursday,

Yay! Happy baby Tarnished! I'll send you some little knitted UFC boxing gloves just to tick off Dash77.

[Guest]

I'm not sure which part of my statement you are claiming is incorrect. So if you could clarify what you think was incorrect about my statement I'd be happy to respond.

In the meantime, an episiotomy is a bit more than a wound. It's a surgical incision. (See the wiki-God) In the US, it's done when the physician feels that tearing is imminent, and is done because it's easier to repair than a tear.

Oh, sorry!

I'm talking about this statement:

* A vaginal delivery with no difficulties probably has very similar medical outcomes as a c-section, but when there is tearing; an episiotomy is required; or the use of forceps or a vacuum is required, the outcomes are significantly worse.

I may not have understood what you said... but a vaginal delivery is a non-medical event. A c-section, is, of course, surgery. Completely different outcomes.

[Guest]

Yay! Happy baby Tarnished! I'll send you some little knitted UFC boxing gloves just to tick off Dash77.

Goodness gracious! I remember that! LOL!!!!

Yeah, Tarnished! Congratulations. Aren't you married to Faded? Congratulations to him too, if that's the case.

[MarginOfError]

Oh, sorry!

I'm talking about this statement:

* A vaginal delivery with no difficulties probably has very similar medical outcomes as a c-section, but when there is tearing; an episiotomy is required; or the use of forceps or a vacuum is required, the outcomes are significantly worse.

I may not have understood what you said... but a vaginal delivery is a non-medical event. A c-section, is, of course, surgery.

Okay. I get where you're headed, but I think you're confusing "recovery" with "medical outcome."

When I speak of medical outcomes, I am referring to things such as infections, complications, readmissions, NICU/PICU admission, maternal mortality, and perinatal mortality.

So among those measures, a straight forward vaginal delivery and a c-section are probably comparable. But those measures are known to be worse among operative vaginal deliveries (vacuum and forceps), episiotomy, and tearing (probably because any of those events indicate, by definition, a complication in the delivery).

[Wingnut]

My baby came last Thursday,

Congratulations to both you and Faded! Very exciting.

[Backroads]

Asked my friend about it... she's done several with, several without, and prefers the natural route because she feels better quicker. Then again, she's very athletic and strong, so she feels her body is set up more for natural birth and admits it might not be the best route for every woman.

[Guest]

Okay. I get where you're headed, but I think you're confusing "recovery" with "medical outcome."

When I speak of medical outcomes, I am referring to things such as infections, complications, readmissions, NICU/PICU admission, maternal mortality, and perinatal mortality.

So among those measures, a straight forward vaginal delivery and a c-section are probably comparable. But those measures are known to be worse among operative vaginal deliveries (vacuum and forceps), episiotomy, and tearing (probably because any of those events indicate, by definition, a complication in the delivery).

I am speaking about infections/complications, etc. etc... as well.

Vaginal birth - is not a medical event. It becomes one when they add medical interventions - like epidural, etc. So, if you treat vaginal birth as a non-medical event, and plan it as such, then it has a completely different medical outcome than surgery.

Because, the incision itself is a medical outcome. While a normal vaginal passage is... nothing.

Am I making sense?

[Wingnut]

I agree with those who have said to leave the possibility open. If you're on the fence about it, don't make up your mind before going into labor that you.will.not. get an epidural under any circumstances. Draw up a birthing plan and make sure that your nurses and husband know that you would like to try it naturally, but you're open to the epidural if you feel like you need it. There are also other pain meds you can take that aren't on the scale of an epidural. Nubain is one. It's a narcotic (safe for labor) that doesn't really get rid of the pain, but dulls it a little. Makes it fuzzy around the edges. I had it, and it helped me relax and sleep when I couldn't otherwise. A friend who had it used to tell people, "I could still feel the pain, but I just didn't care!"

Edited January 27, 2011 by Wingnut

[MarginOfError]

I am speaking about infections/complications, etc. etc... as well.

Vaginal birth - is not a medical event. It becomes one when they add medical interventions - like epidural, etc. So, if you treat vaginal birth as a non-medical event, and plan it as such, then it has a completely different medical outcome than surgery.

Because, the incision itself is a medical outcome. While a normal vaginal passage is... nothing.

Am I making sense?

Not really. I can't help but think that we're using radically different understandings of similar terms. Your use of medical event has me kind of stumped, and your use of medical outcome is nothing like what my colleagues and I consider a medical outcome.

To try and clarify what we use in practice, vaginal delivery and cesarean delivery are just the mode of delivery. A vaginal delivery is not an outcome, nor do we consider a cesarean delivery an outcome. We do report these as process measures, however. But in and of themselves, we do not consider them medical outcomes.

An incision is also not an outcome, but is a procedure. Any time we perform this procedure, we usually have outcomes in mind to follow after the procedure. In the case of incision, we're usually most interested in "wound infection."

As for terming vaginal delivery a non-medical event--I have a hard time swallowing that. Child birth is the leading cause of death for women outside the developed world. It wasn't long ago that maternal mortality was the leading cause of death in the United States. At one point in the 1800's, 40% of women died of child birth. That was down to 1 in 100 by 1900, and estimates float between 11 in 100,000 and 17 in 100,000 in the US today. In the past several years, maternal mortality has been on the rise, and is usually attributed to an increased insistence that there is something inherently bad about medical intervention in child birth, particularly with regards to cesareans.

But you're right about one thing--adverse outcomes are very low among vaginal deliveries with no complications (ie, that do not require episiotomies, forceps, or vacuums). But they aren't any lower than among cesarean sections. In the clinical order of things, physicians prefer first vaginal delivery, second cesarean delivery, third episiotomy, and lastly vacuums and forceps.

However, regardless of the mode of delivery, when we speak of medical outcomes, the medical outcomes for all modes of delivery are the same, ie, we don't distinguish medical outcomes of vaginal delivery from medical outcomes of cesarean delivery.

At this point, it seems appropriate that I state my qualifications to speak on the subject. I work for the 4th ranked Gynecology practice in the United States. My responsibilities include outcomes research and reporting and statistical design and analysis of research related to OBGYN and Women's Health.

Edited January 27, 2011 by MarginOfError

[Guest]

Not really. I can't help but think that we're using radically different understandings of similar terms. Your use of medical event has me kind of stumped, and your use of medical outcome is nothing like what my colleagues and I consider a medical outcome.

To try and clarify what we use in practice, vaginal delivery and cesarean delivery are just the mode of delivery. A vaginal delivery is not an outcome, nor do we consider a cesarean delivery an outcome. We do report these as process measures, however. But in and of themselves, we do not consider them medical outcomes.

An incision is also not an outcome, but is a procedure. Any time we perform this procedure, we usually have outcomes in mind to follow after the procedure. In the case of incision, we're usually most interested in "wound infection."

As for terming vaginal delivery a non-medical event--I have a hard time swallowing that. Child birth is the leading cause of death for women outside the developed world. It wasn't long ago that maternal mortality was the leading cause of death in the United States. At one point in the 1800's, 40% of women died of child birth. That was down to 1 in 100 by 1900, and estimates float between 11 in 100,000 and 17 in 100,000 in the US today. In the past several years, maternal mortality has been on the rise, and is usually attributed to an increased insistence that there is something inherently bad about medical intervention in child birth, particularly with regards to cesareans.

But you're right about one thing--adverse outcomes are very low among vaginal deliveries with no complications (ie, that do not require episiotomies, forceps, or vacuums). But they aren't any lower than among cesarean sections. In the clinical order of things, physicians prefer first vaginal delivery, second cesarean delivery, third episiotomy, and lastly vacuums and forceps.

However, regardless of the mode of delivery, when we speak of medical outcomes, the medical outcomes for all modes of delivery are the same, ie, we don't distinguish medical outcomes of vaginal delivery from medical outcomes of cesarean delivery.

Okay, now I understand where we are different. My mother is a midwife. Midwifery is a completely different philosophy than Obstretrics. And, growing up in the Philippines, midwifery is the common practice in childbirth. Philippines has a more holistic approach to medicine than in the USA.

Okay, so I won't bungle up the explanations... I googled a better explanation of it for you. So, if you may, read a few paragraphs of this first: Midwives Model of Care

It explains what I'm talking about - that childbirth is not a medical event.

Then read the first paragraphs of this one to compare an OB philosophy from a Midwife philosophy:

Choosing a Caregiver: OB/Gyn, CNM, or Licensed Midwife

And for kicks regarding medical outcomes:

Midwife vs Physician: Study Looks at Difference in Rate of Intervention

And my thoughts:

Pregnancy is not considered a medical event until it becomes one or you make it one. Any medical intervention - e.g. adminstration of epidural - makes it a medical event. Any medical issue arising from pregnancy/labor/delivery - e.g. pre-eclampsia - makes it a medical event. Absent these, it is a natural process. There is a completely different method when you treat the pregnancy as a natural event than if you treat it as a medical event. Completely different processes. High risk people - e.g. those with existing medical conditions like scoliosis - should consider treating pregnancy as a medical event. I went into a pre-eclamptic pregnancy towards the end of the 3rd trimester which made my experience a medical event.

Mortality rates are high in underdeveloped countries (Philippines is one) because of the lack of education (e.g. unsanitary practices) or the lack of access to medical help if it turns into a medical event.

So, comparing a c-section versus a natural birth: An INCISION is a medical outcome. That is - a byproduct of a medical condition. Absent the incision, there is no medical outcome just a natural one... like getting cramps after running a marathon or some such.

[Tarnished]

Yay! Happy baby Tarnished! I'll send you some little knitted UFC boxing gloves just to tick off Dash77.

Thanks! My husband and I will love the gloves! Our little one already has the nickname of "Ninja legs" it would be great to have some fighting clothes to go with the nickname.