Westside Doula

The following article is from a wonderful blog: http://www.3doulas.com/

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Epidural or Epi-don't? Pros and Cons of Epidurals

By Aimee Oswald (www.Sweetpeabirth.com)

Recently I had lunch with a new girlfriend.  She is the mother of a 9 month old baby and is often the case with me talk turned to all things baby and pregnancy related.  I decided to tap into this font of new motherhood and ask her "what did you really want to know more about before your labor began"  Immediately a word sprang from her mouth "Epidurals!" she exclaimed, "People either told me to get it right away or to stay away from it but nobody could really tell me anything else". "What did you want to know"? I asked "Everything." she replied. So here it is the pro's, the con's and some of the best alternatives I could find.

What exactly is an Epidural and how does it work?

An Epidural is an injection of a mixture of drugs into the spaces just before the spinal nerves.  In labor the epidural is placed so that the nerves which carry messages from your womb, your lower back, pelvis and perineum are numbed from sensation. To prepare you for an epidural the nurse will first start in IV of fluids, this is an attempt to prevent a fall in blood pressure.  They will then attach an electronic fetal monitor in order to listen to the baby's heart rate.  Next comes the blood pressure cuff to monitor your blood pressure.  The cuff will automatically inflate to take a reading every 15 minutes or so.  When the Anesthesiologist arrives he will have you sit on the edge of the bed with your back curved around a pillow; like an angry cat or rainbow.  He will then tell you that you must sit perfectly still, even if you have a contraction while he inserts the needle into the epidural space in your back. Next he will thread a tiny flexible plastic catheter through the needle and withdraw the needle. Finally he will secure the catheter with tape along your back and over your shoulder. Most commonly these days they will attach the medication to a pump which will maintain your dose at a continuous level.  The epidural usually begins working in 10 to 20 minutes.  It remains in place until after you have delivered your baby.

The Benefits:

• Epidurals nearly always give good pain relief
• If a woman has been laboring for an extended amount of time the relief the epidural provides can give her just enough rest to fully relax so that her labor may continue and she is re-charged for pushing.
• An epidural can help control your blood pressure if it is high while you are laboring.

The Cons:

• Epidurals can slow labor, which results in increased use of pitocin to stimulate stronger contractions.
• Epidurals require continuous electronic fetal monitoring and an IV.
• You will no longer be able to stand, walk or move and will need to have a bladder catheter to empty your bladder. (The catheter brings it's own list of cons)
• Your mobility will be limited, you will no longer be able to walk, stand or move around freely.
• Your blood pressure may drop, which can make you feel sick and dizzy.
• You may need to have an injection to raise you blood pressure.
• You may feel itchy.  If the itchy feeling becomes too overwhelming you will probably be give an antihistamine, which will make you sleepy.
• You may develop a severe headache, usually this can be treated quickly but can sometimes last for many weeks.
• Your body temperature rises over time, so you may develop a fever.  This may lead to an abnormally fast heart rate in your baby and that may lead to you and/or your baby being treated with antibiotics and screened for infection.
• There is an increased risk of your baby being delivered by forceps, vacuum or even Cesarean section.

Even with the long list of cons, many women strongly feel that an epidural is necessary to block out pain. After all, what alternatives are there? Many think that there is no middle ground and that birth has to be either painful and natural or painless and medicated, however many women find that natural birth is absolutely bearable (some even say "pleasant"!) if they are equipped with some alternatives to medication. A laboring mother needn't lay writhing in agony on her back in the hospital bed!

Ten alternatives to an Epidural:

• Encouragement: Have your birth team in place to remind you of have great you are doing and how great your baby is doing. They can remind you to take it one contraction at a time.

• Water: Showers and baths are a wonderful source of peace and relief in labor.  Water helps to lessen anxiety and relieves some of the physical pressure.

• Birth Balls:  Sitting on a birth ball spreads out the pressure on your cervix. Gravity is your friend in labor, so sitting upright will naturally use this force.  Sitting on the birth ball with your upper body resting on the bed is the perfect position for a back massage.

• Breathing:  Whether you use Lamaze, Bradley or Hypnobabies each one involves using a breathing technique to release tension and relax your mind and body...some of the "techniques" are much less structured than others and are simply to be mindful of your breath

• Acupressure: Experienced caregivers know just the correct spots on your body to push to relieve discomfort.

• Movement:  Walking, Dancing and swaying all help in labor.  Again we employ our old friend gravity and the movement can distract from discomfort.  Even if you find a comfortable position you should move every half hour.

• Massage:  Your partner, labor coach or doula can knead you into a lovely state of relaxation.  This will help you rest between contractions.

• Hot/Cold Packs:  Some like it Hot and others prefer cold. Whatever works for you having a pack placed on your back, neck or belly can do wonders to soothe you.

• Vocalizing: Not all noises in labor are screams, many women find great relief in moaning, singing, humming or even whistling.  Find a sound that works for you and let it out.  Think of it this way, open mouth, open cervix- let your baby out!

• Hire a doula: Doulas are trained to support YOU emotionally and physically.  They will stay with you throughout the entire labor and birth and are skilled in most of the above techniques.  They provide a calm presence at times when your partner or family may not be able to.  Studies have shown that among other things having a doula can cut labor time in half. 

So there you  have it: information!  As I always say, "You can't make a choice if you don't have all the information."