Natural Birth vs. Epidural

[annaskids]

I had an epidural for pain medication during my first births and am trying to decide if I should try it naturally this time. I would love to see a discussion about the pros and cons of both choices.

[nhockaday]

I have removed the video b/c it may be offensive for some people.

[Stellajo]

I started labor normally with the birth of my first baby, but switched to an epidural after 10 hours of labor pains  .  With my current pregnancy I will hold out as long as I can when the time comes, but will definitely ask for the epidural again before it's too late 

[RoseMama]

I haven't used an epidural but quite frankly it's the one thing I put on my birth plan in huge letters and said that if I needed a c-section I would not consent to an epidural but would have a general.  They scare me.  The thought of a needle in my spinal fluid creeps me out and I have heard so many negative experiences from people who have had problems with them. 

[SunshineMama]

I didn't use an epidural but I understand why some women would choose to.  Labour just hurts so much.

I didn't use an epidural just gas which I found was enough to get me through the bitey contractions at the end.  The midwife gave me heat packs but I couldn't bear them so I just tried to focus on something else.

I had said that I would consider an epi but never felt like I needed it.

[NadiaD]

Last year while being pregnant I was reading and researching a lot about natural birth and wanted only that,
But my insurance was covering only regular hospital birth, not birthing center.
So let me tell you if you're giving a birth in a hospital it is very unlikely you will have natural birth
I end up getting emergency C-section, so much for natural birth
Anyway, my baby had Apgar score 10 and nursed great even though they brought her to me after 5 hours after delivery,
so do not stress out so much about everything being perfectly by a book
From my experience I would say if you want natural birth, you will need to find birthing center near you or midwife, etc.,
But if your insurance covering only hospital birth, instead of getting ready for natural birth,
read more about early education, parenting, because later you will have very little time for that .

[heyblue41]

I had two hospital births, both natural.  It all depends on the doctor or midwife.  I left a doctor at 32 weeks because after telling me my whole pregnancy that we could do all of the things in my birth plan, that I would be straped to the bed and not allowed to get up at all.  I found a wonderful midwife and hospital that let me do what ever I wanted during labor.  They jokingly said the only place I couldn't give birth was on the toilet!  They let me hold my daughter for over 30 minutes before they ASKED if they could weigh and measure her right next to my bed where I could see the whole time.  They even waited for the cord to stop pulsing before they cut it.  Just ask around especially at the hospital.  Take a tour, they nurses wil tell you if they have a lot of natural births or not.

[kreena]

One inside story of epi birth in the hospital,

Doctors/sisters/whoever there put the mother in labor pain on IV and thr' IV they give
one injection for increasing the labor pain so that the process will get faster.
Due to this increase pain (more than what they could have managed) many impatient women ask for epi. 
again here epi is not covered under insurance !

The best thing one should do is do the regular breathing exercise, regular walk and Yoga !

-- Kreena

[LizzyBee]

I agree Kreena.  This is what is termed a "cascade of interventions" beginning with unnecessary induction of labour, which leads to higher levels of pain without the natural birth hormones kicking in to help manage it, which leads to epidurals, which leads to foetal distress or failure to progress which leads to caesarians. 

So the moral of the story is to absolutely refuse induction of labour or make sure you fully research the risks and benefits of IOL and make sure the dr is not embellishing the risks associated with allowing your baby to be born when they choose.  Term is anywhere between 38-42 weeks so classifying women as post dates BEFORE 42 weeks is incorrect and no reason to induce.

I have to say the whole insurance issue is unfair.  I'm in Australia and you can go to a public hospital which are generally much better equipped and staffed than private hospitals and everything is covered by medicare.  You can also ask for 2nd and 3rd opinions if you want to be sure.  Our system has much room for improvement but at least money and insurance are not a factor in the care you receive.

[PY]

Well I went for epidural..and the next time will be the same...the question is why not? 
One of my friends decided to go natural....she hated life for the first week after giving birth...she was very very irritated even my her baby. She told me the next time I will go for epidural.
But everybody is different some people could handle better or worst.

[2010BEBES]

I have removed the video b/c it may be offensive for some people.

nhockaday and all the administrators of this forum. Congratulations, you really have a lot of work monitoring all that is going on. I can not stop telling my friends all that being here have given me. Not only information for babies and kids but also in human relations. maybe being mostly in english is why they do not participate.

I think something is wrong with this POLL (finally it is not started by me).
we are talking about epidural and the options of the POLL is asking about something else.

[Skylark]

I observed births with epidural and unmedicated births, the number of complications, as well as baby's condition after birth, made me to consider unmedicated birth for myself when I go pregnant. I had unmedicated birth with both of my babies, however I had it in out of hospital setting and had access to other pain-relieving methods, -- hydrotherapy, tens unit (when laboring out of the birth pool), birth massage, freedom of movement, doula support, which in my opinion makes all the difference. I personally probably would not be able to achieve unmedicated birth experience in the hospital setting, as I relied heavily on these alternative pain relieving options and they were very VERY effective. In both situations I labored using various natural pain relieving methods, and had the pushing stage and birth in water. With my second baby I had much harder labor, so I spent more time in the warm birth pool, which SIGNIFICANTLY helped with working through contractions and making them very workable; and I used TENS unit when I was not in the pool. Both of my babies were not small, 8 lb. and 9.5 lb.

It was a great question, PY, "why not?", since I am in medical profession myself and a few of my collegues ( recently an OB GYN and and OB GYN nurse), chose an unmedicated out of hospital birth, we obviously did quite a bit of research on it in medical journals and studies. It will be too much to mention here everything there is :-), but I will just list a few points, which I thought pretty important, at least they were for me as well as to some of my collegues.

So, "Why not?" epidural:

** Significant low blood pressure is a complication of epidural anesthesia. The ways that epiduralized patients must lie accentuate this. Their position is limited since they are essentially paralyzed people for the duration of the epidural. Hypotension occurs among almost one-third of patients with serious hypotension occurring about 12% of the time.
Why is it dangerous during labor? Maternal hypotension is a major risk for the baby. The epidural blocks the nerves which regulate blood pressure. It causes the blood in the body to pool, keeping it from being pumped around the body in the proper manner. The arteries dilate and relax their usual, necessary level of tension, making it difficult for the heart to pump blood to the baby. These changes lead to a decrease in the output of the mothers heart. Less blood per unit time can reach the placenta and therefore the baby.The baby is completely dependent on the mothers heart to pump blood to the placenta to satisfy its needs. All of its oxygen comes across from the placenta. All of the food for its brain and other organs comes across the placenta. Brains cannot live without a relatively constant supply of oxygen and glucose. Without this they become damaged.
A good blood flow is needed to the uterus between contractions so it can get fresh oxygen. During the contraction, blood flow to the uterus is cut off by the muscles contracting. When the contraction stops, the uterus must quickly refill with fresh blood containing oxygen for the baby. If the amount of blood flowing to the uterus is reduced, the baby may not be able to get the oxygen it needs. Then what is called fetal distress may occur. The baby's system does not get enough oxygen and goes into distress. Its blood retains excess acid, the oxygen levels go low and tissues and vital organs begin to fail from excess acid, lack of oxygen and lack of fuel.

** Fetal heart rate decelerations was reported as significant risk following the use of epidurals. Babies have higher chance to develop fetal distress after epidural anesthesia. This may be caused by the mothers blood pressure getting so low that blood cannot be adequately pumped into the uterus to deliver oxygen to the baby. Also, epidurals make it difficult for the muscles in the arteries of the lower body to respond and to keep blood adequately flowing through the body. The ability of the heart to respond to changing needs of the body is impaired. Eberle and Norris1 suggest that nduction of maternal analgesia may transiently alter the balance between factors encouraging and discouraging uterine contraction. A temporary increase in the uterotonic effects of endogenous or exogenous oxytocin may then produce a tetanic contraction with subsequent decrease fetal oxygen delivery and resultant fetal bradycardia.

** Accidental injection of the anesthetic solution into the blood stream can occur and can cause the mother to twitch, have convulsions, or lose of consciousness. Seizures can occur from the toxic effects of the anesthetic agent entering the blood stream. The chances of that is about 12-16 in every 1000, however I was a witness if this reaction, and believe me, I did not want to take a chance after that...

** Trauma to blood vessels can occur as a result of epidural anesthesia.In one study, bleeding in the spinal column and unintentional placement of the catheter into an artery or vein occurred 0.67% of the time (67 women of every 1000 epidurals).The catheter actually escapes outside of where it is supposed to go 1 to 6% of the time.
Hemorrhages can occur around the spinal cord and even within the skull following epidural anesthesia.These were associated with persistent backaches or headaches. Failure to treat these problems usually results in permanent paralysis. Surgery must be performed within 8 hours of the onset of paralysis or the prognosis is poor.

** The actual dura may be punctured as a result of epidural anesthesia. Because of the large size of the needle used, severe headache may also result. Dural punctures have been found to occur about 1.8%

**Backache after an epidural is a common complication. Back pain commonly occurs after epidural anesthesia (18.9% of the time). Upper back pain can happen at some distance from the site where the epidural is injected.The back pain can last very long-term.Nineteen percent of women had long-term backache after epidural anesthesia. It probably results from a combination of its effects on the nerves and from extreme postures and stretching that occurs after the epidural during labor.

** Uterine contractions can become weaker and less frequent. An oxytocin infusion is then necessary to improve labor and produce good strength contractions Mothers having epidurals have longer labors and have a higher incidence of the use of syntetic oxytocin than mothers having non-medicated deliveries.

There are important risks of  having pitocin augmentation. Administration of this hormone to the mother during labor can cause:

   1.   Dangerously high blood pressure.
   2.   Abnormal heart rhythms.
   3.   Nausea and vomiting.
   4.   Sustained uterine contractions which last too long and result in the baby going into distress from lack of oxygen. When this is too severe, the uterus can rupture. The epidural can mask the strength of the uterine contractions so that no one knows that how strong they are, making uterine rupture more possible.
   5.   Hemorrhage around the brain.
   6.   Retention of water leading to convulsions and coma.
   7.   Bleeding in the pelvis and increased incidence of postpartum hemorrhage.
   8.   Death of the baby.
   9.   Jaundice of the baby.


** With large doses the patient loses the desire and the ability to bear down and push. This results in an increased use of forceps and vacuum extractions over women having unmedicated deliveries.

** The epidural is generally inadequate 7.1% of the time, leading to supplementation with intravenous pain medication 4.0% of the time and a general anesthetic 3.1% of the time (in one study)

** When an epidural accidentally turns into a spinal anesthetic, many complications can occur:

   1.   Postspinal headaches.
   2.   Dysfunction of the bladder is frequent
   3.   Occasionally numbness and tingling (paresthesias) of the lower limbs and abdomen develop, and sometimes there is a temporary loss or diminution of sensation in these areas.
   4.   Unilateral footdrop (paralysis of the muscle that lifts the foot) has occurred.
   5.   Permanent nerve damage (conditions called chronic, progressive adhesive arachnoiditis or transverse myelitis) can occur. These lead to paralysis of the lower parts of the body.
   6.   Deaths have been reported.
   7.   Difficult breathing
   8.   Increased incidence of forceps deliveries.


** The lack of ability of the heart to pump blood around the body (from low blood pressure or pooling of blood) can become so severe that a heart attack occurs or the spinal cord will suffer damage from not enough blood reaching it.

** Asthmatics can get suddenly worse during epidural anesthesia37 with more wheezing and inability to breath.

** A hidden danger of epidural anesthesia is its interaction with medications (prostaglandins) commonly used to soften the cervix and start labor. The use of prostaglandins is common at hospitals and creates a potentially dangerous situation in which the usual medications used to treat low blood pressure during labor will no longer work.

**  women who have migraines can have more visual disturbances after epidurals.
**Maternal fever and even the severe condition called malignant hyperthermia (dangerously high fever) can result.

** Mothers can stop breathing (respiratory arrest) and can experience other breathing difficulties.


** Other neurological disabilities (including a condition called Horners syndrome) can develop along with hoarseness (from even just one dose of epidural anesthetic) It is found impossible to predict which patients would develop a Horner's syndrome. Even the nerves to the face can be blocked, sometimes temporarily, sometimes permanently.Tremors and shakes can occur.
Paresthesias (persistent tingling from sensory nerves) occurred in 0.16% of patients in one study (1.6 per 1000) with an incidence of persistent neuropathy of 0.04% (4 per 10,000). Four of these patients had a neuropathy which eventually resolved. In another study 3.0% of patients had tingling of the hands or fingers, while 26 of almost 5000 women had persistent tingling or numbness in the lower back, buttocks or legs.
Dizziness and fainting can become a problem after epidurals. One study found these symptoms persisting in 2.1% of women.


** Twenty to 30 percent of women experience nausea after epidural anesthesia, while 3 to 7% have vomiting.53

** A dangerous allergic condition with shock (called anaphylaxis) can occur.The woman develops a red rash (erythema), itches, and her lungs fill up with fluid (pulmonary edema). Excessive lung fluid is also found in the babies in these cases.

** Mothers can experience excessively slow heart rates (bradycardia), heart block in which the electrical activity of the chambers of the heart become dissociated and sometimes even stoppage of the heart (cardiac arrest).

** Headache after epidural is a persistent problem that is more pronounced in younger patients.57 One study found its incidence after epidural anesthesia to be 4.6%, significantly more often than women not having epidurals.

** Epidural anesthesia can produce motor blockade, resulting in temporary paralysis, even of respiratory muscles.60

** Epidural analgesia is associated with recurrence of herpes simplex blepharitis after cesarean section when epidural morphine is given.63

** A disabling condition called spinal arachnoiditis can develop after epidural anesthesia. 
**  Paralysis can occur.The injection of the local anesthetic into the epidural space can result in the veins becoming engorged, the spinal cord suffering from a lack of oxygen (hypoxia) and the woman developing acute neurological problems. Some of these deficits can become permanent.Paralysis can also occur from bleeding into the area during the epidural injection with the formation of a pocket of blood pressing on the spinal cord (hematoma). It can also occur from infection or trauma.
Cranial nerve paralysis can occur at quite a distance from the site of the epidural. This is thought to occur from traction on the spinal cord.
Paralysis can occur from a condition called anterior spinal artery syndrome after epidural anesthesia during labor.

Hope this is a help...

[Skylark]

Oh, and I forgot to mention, natural birth, properly managed, does not need to be horrible and in actuality ( and I witnessed activities of over 50 natural birth mommies, myself included  ) after the natural birth recovery is much much faster. With my first baby I was discharged and able to go home 5 hours after birth, rested for the next day ( was exausted, and wanted to sleep) and was up and about on the second day, visiting friends. With our second baby, I was discharged 7 hours after the birth, and 2 days later we left for our "baby-moon", -- little vacation to rest and relax and adjust to our new baby. I consider both wonderful experiences and while it was a hard work, it was managable and excillirating. But as I mentioned earlier,  A LOT DEPENDS ON PROPER PROVIDER AND CARE

[Mylittleones]

My baby was born after a long hard labor, halfway through I thought I would pass out from the labor pain so I asked for an epidural. The drugs injected into my spine only worked down my left side and the baby's heart rate dropped dramatically. The doctor said that if the epidural had worked as it should have it would have slowed down the labor process and the baby might not have made it out in time.

At my sister's home birth, she had no drugs, at all. She gave birth in a squatting position. She said that it helped immensely having gravity to help the process along. She also told me that once the baby was crowning that the pain lessened (the midwife said this was due to the baby's head blocking off the nerves to the area) and she could concentrate on getting the baby out. After the baby was born my sister was up and walking around within a few minutes, where as I was in bed for hours and couldn't feel my left leg.

I think this time I will go without the drugs.

[Marmee]

Oh Mylittleones how scary for you. 

Skylark, such fantastic information.  Thank you!

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