*for me. Just as each woman and birth differ, so do a woman’s reasons for choosing to prepare for birth the way she does. These are mine.
The trouble with epidurals is not that they take away pain — that is the good thing about epidurals. Choosing pain over pleasure is a sign of genetic defect in laboratory animals; it is not a good recommendation for humans, either. The trouble with epidurals is not that they take away from “experiencing” the whole miraculous thing, beginning to end, with no oblivious gap. (This is a drawback for many women about epidurals, but there are many painful aspects of life I would rather not subject myself to if I can avoid it, like shopping for a bathing suit.) Some women want to do nothing that would interrupt or change the natural order of things. This is an admirable motive for not wanting an epidural, but it is not one of mine. (I think.) (Actually, it is, but then I might feel differently about “nature” after experiencing “natural.”)
And the trouble with epidurals (for me) is not even the potential side affects associated with the epidural medicine or procedure itself, which can include (but are not limited to) 1) spinal headache, 2) sluggish baby, 3) prolonged or excessive inability to move one’s legs, 4) cardiac arrest for mother and abnormal heart rate for baby, and 5) a numb patch on your right leg for months. Of these (rare to very-rare) complications, only the last has happened to me with three less-than-stellar epidural experiences. The most annoying part of my epidurals (so I thought) was that my spine didn’t cooperate so I still had pain on one side and then after subsequent doses, I had absolutely no hope of staying on the bed without help.
The trouble with epidurals is two-fold and relates to the requirements that go along with getting one. First: with an epidural you have to labor in the absolute worst position physiologically, a position (lithotomy/flat on your back) in which gravity works against you, and in which the pelvis/cervix are able to open much less (I have read, up to an inch less) than in a squatting or all-fours position. (Of course it would be even worse to be strung up by your toes, but not much.)
The second requirement is constant electronic fetal monitoring, which increases interventions like forceps and vacuum-extraction deliveries and c-sections, without improving fetal outcomes. C-sections may seem like no big deal for some women, but even when they are medically necessary (and thank God they are available when needed, right?), they are still major abdominal surgery that affect how the mother is able to conduct her life even months later, much less in the days and weeks following birth (a time that already strains a woman’s emotional, mental, and physical faculties).
If there were a magic pink pill that took away all pain sensation from the waist to the pelvis while retaining sensation of muscular positioning and contraction and all motor function of the legs and trunk muscles, with a one hundred-percent guarantee that there was no effect on or transmission to the fetus and no risk of side effect to the mother, of course I would sign up tomorrow. Of course.
The trouble with epidurals is that they are not that magic pill.
The trouble with much of modern obstetrical practice is that epidurals are too-often presented to the pregnant woman as being that magic pill. For my previous three births, I was given information regarding the very slight chance of spinal headache, etc, but no one told me, and I didn’t think to ask, that laying on one’s back was not only NOT the only way to give birth but actually the least-helpful, least-physiologically-indicated position, and that electronic fetal monitoring would not, in fact, make my baby safer.
Those are two hefty omissions.
Which is not to say that epidurals don’t have their place or that women who choose them are in any way “less” somehow than those who do not. For some, epidurals are close enough to that magic pink pill that they are only logical. For others, a very careful weighing of the benefits and drawbacks is necessary, and that weighing can only take place when ALL of the benefits and drawbacks are known and considered.
Now that I know (and am continuing to learn), I am still open to the possibility of getting an epidural; I am not so determined to “experience it all” that I would ignore the actual sequence of events that is this unique, fourth, birth. For example, if I have days of back labor that exhaust my resources without progressing, or if I realize that I’m not dilating completely because instead of being able to relax into, surrender to, or work with/through the contractions I’m instead reverting to my natural inclination — to tense against pain — and that an epidural at this late stage is the only way to get the baby out of me (this assumes I am stalled enough that there is actually time to get the anesthesiologist there), then I would choose to have one. Because in either of those scenarios the two drawbacks to an epidural would be of less concern at that point.
And in the end, epidural or no epidural (vaginal or emergency c-section) I will have succeeded in doing it my way, the way that seems best to me after learning all I can, which is all I ask of life. (Well, that and a trip around the world at some point.)
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Great post. I think that your last lines say it all. That no matter what you are going to do it your way. And that is what is important. That each woman educates herself and has the birth she feels comfortable. Not something that she feels forced into.
I find this to be such a fascinating topic. I had a great experience having an epidural with my first (and currently only) baby. It was the best I’d felt in nine months. And I’ll probably have one again next time, because I am a total wimp when it comes to physical pain. Though there is that sense of mystery – what would it be like to have a natural birth? Our bishop’s wife is a doula, and has had seven kids, all naturally. If she can do it – and if Ricki Lake can – I’m sure I could, too. But do I want to? I don’t know. Maybe.
I’m not sure having an epidural will always be an option for me, since my first birth went so quickly. They told me I’d better live across the street from the hospital next time I have a baby.
Have you seen The Business of Being Born? What did you think of it?
Jane Reply:
March 24th, 2010 at 7:40 am
My first labor was 28 hours long, though a lot of that was waiting for the induction to get going. Then I had 5 hours of pitocin-strengthened contractions before the anesthesiologist got there, and 2 hours of pushing, during which they “turned off” my epidural. (My first was 41 weeks and 9 lb 3 oz). My second and third labors were much faster; I pushed 8 times with the second and only once with the third. Those epidurals were also better because I knew to warn them I only got pain relief on one side initially (always the left side). So taking that all together, I think I can handle the pain, so long as this birth follows the pattern of getting faster/easier, and so long as I don’t need to be induced (I don’t plan to get induced unless there is a VERY convincing reason to, because Pitocin is basically evil.)
But to answer your question
, I haven’t seen BBB yet. So far I’ve read several books — I’ll post a list soon, and I plan to watch BBB and Orgasmic Birth, and to watch/listen to? the Hypnobirthing stuff.
I like your insights and research.
I’ve had three without anesthesia and two with epidurals. In my most recent delivery I had to be induced early because of life-threateningly dangerous hypertension, and I don’t know if my baby or I would have survived without the epidural, which both helped regulate my blood pressure and made it possible for me to endure labor while in a significantly weakened condition. Also, in our case the electronic monitoring may have saved my baby’s life, because the delivery nurse was able to observe that Hazel showed distress depending on the position I labored in, so she kept me in a position that didn’t depress Hazel’s heart rate. Sure enough, Hazel was born with the cord around her neck, and the nurse’s careful adjustments to my position (she had me lying towards one side with one hip elevated) really may have saved Hazel’s life or prevented brain damage.
That said, I’m still happy that I was able to have my first three labors without anesthesia; it’s hard to explain what’s so joyful about enduring more pain, but it really was thrilling to me to experience that I could do that, and to feel more free and less unencumbered. (But wow, that third one did hurt. My baby was big with broad shoulders, and it was at least three weeks before I could recall that labor without cringing and wincing.)
Jane Reply:
March 24th, 2010 at 7:55 am
Zina — Your stories are exactly what I’m talking about — being prepared to do it one way, but flexible enough to go with what needs to be done for the baby (and you) and being able to be satisfied with the outcome (whatever it is, I mean, unless the baby dies of course, you don’t have to be satisfied with that), so long as you feel like you were an active, respected participant.
On the monitoring, I’ll have intermittent monitoring by Doppler, which will pick up problems like you describe w/ Hazel, and if something like that is noticed, then of course continual EFM would be instituted and I would be fine with that.
It’s interesting that the epidural was able to help your blood pressure (and labor while in such a dangerous condition), but that it probably also contributed to (or didn’t help, anyway) the baby’s heart rate. And it’s good that even with an epidural you were able to get into a different position. My sister had a similar thing (not the eclampsia, but erratic fetal heartbeat after an epidural and pitocin), and the nurses were able to get her into a hands-and-feet position, which is also better for baby’s heart. With my epidurals, there is NO WAY I could’ve gotten off my back. I was soooooo numb.
Also lucky is that you were able to avoid, with the nurse’s vigilant care, having a c-section — my sister ended up having one (and then a VBAC and then a c-section bec. she also had a grapefruit-sized cyst during her 3rd pregnancy). Really, I think you owe that nurse a big sloppy kiss (or some chocolates!), because I think many nurses/doctors wouldn’t even have known how to help you labor vaginally in that situation (because so often they wouldn’t let that progress but cut directly to c-section so they just wouldn’t have the experience), and so many also would go directly/immediately to c-section for legal fear, rather than working with you and doing what turned out to be best for you and Hazel.
(I hope my interpretation is okay here. I know I don’t know all the facts, but it sounds like everything went as well — actually better — than could be expected, and I honestly think at least part of that was your own experience of having the first three “naturally.”)
Finally (sorry, this is getting long) — one of the reasons we induced my third was bec. my first was 9 lb 3 oz (w/ the painful pushing), and my second was 7 lb 13 oz at almost 3 weeks early (we had an induction scheduled for her but my water broke and out she came). So we were sure my third would be huge too, but she wasn’t (7’5). I know usually babies get bigger and bigger, but I’m hoping (for obvious reasons) that this one follows her/his third big sister’s example.
Zina Reply:
March 25th, 2010 at 11:06 pm
Yes, I think the skilled and vigilant nurse DID save me from a c-section–which would have been almost a given with some practitioners–and yes, I was VERY grateful. I’ve actually used midwives with all my labors but the Mt. Timp midwives now work at two hospitals and this time my midwife was at a different hospital for most of my labor, which I would feel more peeved about if the nurse hadn’t been so great.
After reading the comments below, I’ll add that, although before I had my first I’d thought I would want to try squatting or some other position for delivery, it’s never worked well for me. I prefer to semi-recline and then at the end the midwives have me pull up my knees and my husband and mom help support my legs. My third baby (the one with the big shoulders) was posterior (that’s probably another factor in why I remember her birth as being so painful) and we did get her turned by my getting on all fours for ten contractions. That was ALL I could stand to do; I just couldn’t manage the pain as well in that position.
Zina Reply:
March 26th, 2010 at 9:43 am
I forgot to say that I did labor on a birthing ball for pretty good stretches w/ a couple of my labors and I did find it helpful and (relatively) comfortable.
Zina Reply:
March 26th, 2010 at 9:44 am
I sat/squatted on the ball, with the ball on floor by the bed, and me I leaned my arms and head forward against the bed.
Jane Reply:
March 29th, 2010 at 11:08 pm
Thanks for all your comments Zina. I think all this mechanical/logistical help — hearing how differently it works for different women — will come in very handy.
For me, though I had to have an epidurals to go with my pitocin drip and two days of labor (only 11 hours actually pushing, thankfully), the thing that scared me the most was the catheter. I hated the feeling, I hated the nurses telling me that if I couldn’t pee on my own after it was removed, I’d have to have it back in and come back to the hospital a few days after going home with the baby.
If you can do it, more power to ya!
Jane Reply:
March 24th, 2010 at 9:11 am
“only” 11 hours of pushing? I think I’d be screaming for the morphine, or a mushroom bomb, at that point
.
Yes, a catheter is almost always required with an epidural, and besides the possible complication you list, each incision/insertion point like that is a possible entry point for infections like MRSA. So yeah, not a happy thing.
I don’t have anything intelligent to add but wanted to let you know I am thoroughly impressed with all your research and love the way you think.
I don’t always comment on your birthing posts, mostly because I realized it is no longer a part of my life and I don’t have enough interest to even give my point of view anymore. (And now I will instantly make myself a liar by commenting)
But I love this post. You hit near my exact feelings on the matter. I loved giving birth naturally. It was a rush. But then again I loved my one epidural- for me it was literally a magic pill (no pain and no side effects).
A few points about my experience:
I did labor and push (for hours) on all fours. There is no one in the world who can convince me that is a more natural, easier way to go.
I requested a catheter for my last half of children after I found out it was not NORMAL to pee all over your doctor in the middle of pushing. It (the catheter) didn’t bother me at all. I always thought the pee was my water breaking, but it wasn’t. My water never broke without the crochet hook until #6, when it broke at home and I barely made it into the hospital (so you could say I birthed most of him standing up- also not so comfortable).
I think I was profoundly lucky with my oldest. Despite her posterior position which she kept returning to, even after turning her during contractions, I was birthed completely natural (but on my hands and knees). Also, the doctor allowed me to tear (deeply) instead of episiotomy and I never tore or anything with any of the other 5 children. Lastly, I had decided to try natural unless I needed otherwise and I didn’t and found the natural labor expereince profound.
Jane Reply:
March 25th, 2010 at 9:53 am
Just to clarify — so you felt that laboring on all fours was NOT a natural, easy position? Did you try squatting? Did you like lying on your side? On your back? Did you have towels or a pad to kneel on (I am all ears about the mechanics/logistics of this sort of thing right now
.
Was there a reason (besides hurrying labor) to break the waters at all? From what I have read, it seems like keeping the waters intact for as long as possible is nice for the baby (and mom) because it cushions things. ? (Susan came almost 3 weeks early when my water broke at home, so obviously I know it’s not always possible, even if it is? desirable, to keep them intact.)
Also from what I have read, episiotomy usually *increases* the chance of a 3rd or 4th degree tear — the statistic I think was by 9 times, but I need to look that up again. I tore with my first (just 28 stitches), but much more painful and longer to heal was the swelling and ground-meat feeling from the 2 hours of lithotomy pushing of a 9lb+ baby. That was the single most shocking thing to me about that birth. I had NO IDEA my lady parts could look/feel like THAT.
Charlotte Reply:
March 25th, 2010 at 10:23 am
I hated being on all fours. I was on a bed with lots of pillows and stuff, it was just long and miserable and uncomfortable to me. I remember just wishing that I could pause time for a minute and rest between contractions and pushing. But of course, I couldn’t.
My second was also posterior but a few minutes on my side turned him.
For me the most comfortable was probably on my back or sitting. But then again, I didn’t ever labor long ever and never pushed more than a couple times after my first. Maybe that is why I have such bad memories about being on all fours, because it was so much longer than all my other pushing experiences?
Most of my waters were intact until the head was actually into the birth canal and the sack was coming out with the baby. (At least that is how I remember it- I’ll be the first to admit my memories of birth are a little distorted from the intensity of it all). Only one was broken to make labor go faster and I was already dilated to 9.5 and was feeling the urge to push, but the baby wasn’t entering the canal yet.
I’ve heard that episiotomy statistic, too, I think from the doctor explaining why he was going to let it tear instead of cutting. Also that a tear will heal better than a cut and so the chances of tearing again are less?
I did, however have to be cut open before I got married. I had an microperforate hymen (I think that was it). I wonder if I just tend to make really strong, not easily broken woman parts?
It is hard for me to adjust my experiences because I have a pretty high pain tolerance and was able to focus the pain into one spot on the ceiling during contractions. It was just natural to me and I have no idea how it is for someone without that natural inclination.
The only problem-free delivery I experienced was a natural delivery in the 97th ARMY General Hospital in Frankfurt, Germany. When I delivered my other 3 boys back in the state’s modern hospitals (for the times), I encountered one fiasco after another, and they all ended up as C-sections.
But I believe women have the right to choose their mode of delivery as we are all so different.
Hi Miss beautiful Jane/Shannon!
I don’t know if you knew this, but I’m also a doula. I’ve attended nearly two hundred births and am also one of two doula trainers in Utah. I really appreciate your post. I see so many posts that are not balanced or based on research regarding epidurals. The majority of women I work with choose to give birth without medication, although I always have a handful of women who choose to give birth with an epidural. The bottom line is that it is almost always safer to give birth without medication, but every woman should have the right to choose how she gives birth, where she gives birth and with whom she gives birth. The clients that birth with me that choose to have epidurals are very well educated on the risks associated with an epidural. They generally hire me as already well-educated women and the journey of giving birth is a woman’s right to experience in whatever way she deems best for her life and I am not here to choose her life path, but to SUPPORT her.
One point I’d like to make, however, is that I hear a lot of stories from women who say that medical interventions like continuous electronic fetal monitor (EFM) saved their and their baby’s life. I just want to make the point that this is true in only a tiny fraction of cases (for example in the case of a long drawn out prodromal labor when rest is the number one priority in a safe birth). Most of the other problems we may encounter in birth are either improved by having all one’s physiological faculties, ie., freedom of movement, freedom to eat and drink, spontaneous pushing, etc., or exacerbated by things like continuous EFM (as opposed to intermittent monitoring), epidural, pitocin, confinement to the bed, etc. Many of the things the women describe above are actually iatrogenic problems, that is, “doctor caused.” For example, let’s say you started out with a posterior baby and your labor stalled. An epidural and pitocin will only cause your baby to become more stuck and will give it less ability to turn to an optimal position. Then comes the cesarean for lack of progress. So, my desire for women to do their best to have a normal birth is not because I like to see women in pain, but because I like to see women and babies in HEALTH and a normal physiological birth is the best way to insure this.
That said, many women are deathly afraid of giving birth without an epidural. Some things that help are to get educated about the true processes of labor and birth and why we have pain. Choose a care provider that will support your body in giving birth, not one who will manage your birth according to their professional or personal schedule. Remember that if your body can create the pain of labor and birth, it means you’re healthy and that you also have the ability to manage it. Consider getting a doula. Doulas know all the physiological positions and tricks that make labor and birth easier. If you still choose an epidural, there are ways to make it a safer choice: Wait as long as possible to get it. Move around as much as you can before you get it. Request a light epidural (you can always turn it up). Ask that it be turned off when you’re ready to push (the more you feel, the faster and more effectively you will push your baby out).
I hope this helps some of your readers! I’m proud of you and the choices you’re making. Remember that you can do whatever you choose. Your great grandmother and her mother and her mother and her mother all had successful unmedicated births, otherwise YOU wouldn’t be here! Cheers!
Jane Reply:
March 29th, 2010 at 11:12 pm
Melissa, Thanks for sharing all this wisdom. Everything I have read and learned so far this time tells me that you’re right on. I am reading a good list of books from my friend Rixa: http://rixarixa.blogspot.com/2010/01/preparing-for-natural-hospital-birth.html And I’m lucky to have a cousin who homebirths allow me to be present at her birth a month before I’m due.
I’m not sure about my great-grandmother (From all accounts, she may have had some moonshine aiding her
), but I agree 100%! I can do this (repeat, repeat, repeat 
.
(And how come I think my ears should have been burning last Saturday during your Raw Melissa class? Sorry I missed it, hope to catch you in person again soon!).
My trouble with epidurals is that they’re administered through a long, long needle into your spine during labor. Just the thought of a shot in the back is enough to make me quake with fear.
So what did I do? Had all 3 babies the natural way. Though I would have accepted laughing gas if that had been an option.