Epidurals and Pain-Free Childbirth

Of the four million births in the U.S. each year, approximately 65 percent—2.6 million—now incorporate pain relief by epidural.

Determining whether an epidural—or any medical pain management at all—will meet your physical and emotional needs is a decision that requires diligent research and personal reflection. Dr. William Camann, director of obstetric anesthesia at Boston’s Brigham and Women’s Hospital, has been in practice for 22 years. He emphasizes that pain management is too highly personal to allow for judgments.

“The most important thing is informed choice and knowing what the options are,” Camann says. “Expectant mothers should know what each pain-relief option involves regarding benefits and side effects. Then she should be free to make an informed choice without being subject to some agenda-driven guilt trip from one side or the other.” Knowing what options your hospital and obstetrician offer will also allow for changing your plan depending on the course your labor takes.

Camann is the author of Easy Labor: Every Woman’s Guide to Choosing Less Pain and More Joy During Childbirth. He notes the passionate reactions prompted by an article his co-author wrote about her personal experience with labor pain.

Epidural drugs do cross the placenta and reach the baby—to relatively little effect.

One reason epidurals have gained popularity is the drugs are not absorbed into the bloodstream to the same extent as ingested or injected narcotics. Drugs applied via epidural do exist in the bloodstream, which reaches the baby, but in very low concentrations. Rather than having a system-wide effect on the mother, epidurals block sensation in lower-body regions by bathing the nerves in the anesthetic or narcotic (analgesic).

“The drugs used for epidurals are very short-acting and wear off within hours after delivery,” says Camann. “There’s no reason to suspect they would have long-term effects.”

Many women prefer natural childbirth and find organic methods to be effective.

There are nearly as many methods of pain management as there are personality types. Husbands who once arrived at the maternity ward with nothing but sweaty palms and a box of cigars now tote duffel bags packed with candles, aromatherapy scents, pictures, meditation tapes, foot massagers, massage oils, hot/cold compresses and MP3 players.

Of all the drug-free techniques, water applications appear to be the most popular and helpful. Almost all labor units now have shower units, tubs or a Jacuzzi available. Says Camann: “If you’ve ever had a muscle cramp or a hard athletic workout and your muscles are sore, you know that you feel better after letting the shower beat down on you or after taking a nice, hot soak. The same thing happens in labor, and [the water treatments] are very effective.”

Expectant mothers who plan on an epidural should also plan on being wired up.

Once the epidural catheter is placed, several procedural necessities follow. The patient is usually restricted to bed for the duration of her labor. Because decreased blood pressure is a well-documented risk, an IV is required to hydrate the mother with intravenous fluids. Two monitors are strapped to the mother’s belly, one for the baby and one to check contractions. Urinary sensation sometimes is lost, necessitating a Foley catheter into the bladder.

A significant advance in the past decade is the incorporation of patient-controlled epidural anesthesia, or PCEA. Just like patients recovering from surgery can administer their own morphine or Demerol by pushing a button, women can directly control the amount of epidural drugs they receive. An anesthesiologist calibrates the system for each patient individually, and safety mechanisms prevent overdose. Studies have shown that patients use less medication on PCEA without bearing any more pain or side effects.

Epidurals do not increase one’s chance of a C-section delivery.

In 2006, both the American Society of Anesthesiologists (ASA) and the American College of Obstetricians and Gynecologists (ACOG) revised their guidelines for obstetrics and noted that receiving epidural anesthesia does not increase the incidence of cesarean delivery. The organizations also dispelled the notion that epidurals should be withheld “to meet arbitrary standards for cervical dilation.” Translation: A woman can receive an epidural at virtually any time during active labor, whether she is at 2 centimeters or 9 centimeters.

Mothers planning on natural childbirth sometimes need to change course during the singular experience of labor and delivery. One sound recommendation any obstetrician, doula or experienced woman can offer is to expect the unexpected. And once labor is behind you, that’s not a bad principle by which to raise children, either.

More Information:

• Download ASA Labor and Delivery Pamphlet
• American Society of Anesthesiologists
• American College of Obstetricians and Gynecologists

Confused by health myths and misinformation? Each week, Rich Maloof talks to leading health experts to bring you the straight facts on a broad range of health topics.

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