Gone are the days when women had no choice but to endure labor and delivery without medication to ease the pain. Nowadays, options like epidural anesthesia can make the inevitably painful experience of childbirth calmer, controlled and, yes, even comfortable.
Today, epidurals are the most popular method of pain relief during labor. More than two-thirds of women giving birth at hospitals in this country request one.
Of course, some women hope to get through childbirth without needing any medication. But once labor starts, it’s common — and understandable — for a woman to change her mind and request assistance to alleviate her pain. No matter how prepared you are, physically and mentally, giving birth is hard.
“Choosing whether or not to get an epidural is a very personal decision,” said Dr. Stacey Ehrenberg, a maternal fetal medicine specialist at Akron Children’s. “We see many women decide to go natural, and as the patient’s care provider, we are always here to support their decision. But, there’s really no other medical situation where someone is having that level of pain and opts out of medicine.”
Whether you’ve known from day one that you’ll be asking for an epidural or have your heart set on a medicine-free birth, knowing the benefits versus risks of epidurals may eliminate the pain of deciding whether to get one.
Benefits
Pain control is obviously the biggest benefit of an epidural during labor and delivery, but there are several other advantages, as well.
When a woman is in pain, she tends to breathe faster and her body releases increased amounts of cortisol or other hormones, which can increase the fetal heart rate. Simply put, some babies don’t tolerate labor as well when a mom is in pain. With an epidural, these adverse effects on the baby can be avoided.
There’s also a misconception that epidurals slow down labor.
“Of course, not having anesthesia is more natural in the sense of not taking medication, but it doesn’t necessarily mean a better, safer or faster birth,” said Dr. Ehrenberg. “An epidural helps the body relax and potentially dilate faster. In fact, an epidural is the first thing we recommend if labor isn’t progressing and the cervix isn’t dilating.”
Studies show during the first stage of labor (dilation), it’s 90 minutes shorter for women who get an epidural versus pain medications through the IV. However, the second stage of labor (pushing) did take, on average, 13 minutes longer for women with an epidural.
“When you’re pushing comfortably, it’s not a significant difference,” Dr. Ehrenberg continued. “When administered correctly, women do retain some sensation with an epidural – and most women push well.”
Epidural anesthesia also works significantly better than a local anesthetic for repairing vaginal tears after delivery. Because of this, it allows a woman to comfortably interact with her baby and even breast-feed during the repairs.
Another common concern is that the medicine is not safe for the baby. But because of where the catheter is placed, the anesthesia in an epidural does not pass through the placenta and, therefore, doesn’t reach the baby. However, if a woman who wants to avoid an epidural needs anesthesia in an emergent situation, it can put the baby at unnecessary risk.
“Pain medications like narcotics, given orally or through an IV, do reach the baby and can make him more relaxed and less alert after birth,” Dr. Ehrenberg explained. “This can affect the baby’s ability to breathe and suck.”
Risks
The 2 most common risk factors, or side effects, from epidurals are low blood pressure and itching. Itching can be controlled through medication, and your care providers pretreat low blood pressure with extra fluids. If low blood pressure persists, additional medication is given to bring it back up. Both risks are easily corrected.
Overall, epidurals are overwhelmingly safe, with an overall complication rate of less than 1 percent. Dr. Ehrenberg notes that in a recent study of more than 300,000 women who had epidurals during labor, there were no maternal or fetal deaths related to the epidural. “I definitely think the benefits of an epidural outweigh the risks,” she shared. “Without question, an epidural is a safe option that doesn’t affect the baby for the relief of labor pain, which is often the most pain a woman may ever experience. I hope all women will consider it if it’s recommended by their provider.”
