Natural Childbirth V: Epidural Side Effects and Risks | Chris Kresser
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Natural Childbirth V: Epidural Side Effects and Risks

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Before we dive into a discussion of epidural analgesia I’d like to clarify my intention in writing this series in light of some of the comments on previous articles.

The purpose of this series on natural childbirth is to demonstrate that homebirth is as safe – if not safer – than hospital birth for low risk pregnancies, and that medical interventions commonly used in hospital births such as epidurals, induction with synthetic oxytocin and cesarean sections have risks and complications that are often not communicated to pregnant women.

Currently fewer than 1% of births happen at home in the U.S., and I believe this is largely due to misconceptions about its safety. My intention here is to correct those misconceptions.

The purpose of this series is not to condemn the use of these interventions in all circumstances. All of them have their place, and can be very helpful and even life-saving (for mothers and babies) when used appropriately. In fact, I said the following in bold text at the end of the first article in this series:

I want to be clear: no matter where birth takes place, complications may arise that require medical intervention and I am 100% in support of it in these cases.

There is still much we don’t understand about birth, and even more we don’t have direct control over. In some cases, despite a woman’s best efforts to have a natural, undisturbed birth, complications arise that require medical attention (and transfer to a hospital if she started laboring at home). In these circumstances, I absolutely endorse taking advantage of whatever interventions may protect the health and safety of both the mother and baby. At the end of the day, that is far, far more important than the method by which the baby was born.

I also want to be clear that I am not judging women who choose to have hospital births, receive epidurals, induce with Pitocin or end up having a cesarean section. I respect the right of women to choose a method of childbirth that feels safe and comfortable for them.

My purpose, instead, is to tell the side of the story that women are often not told, and to raise awareness of the risks associated with these procedures so that when it comes time to make their own decision, women are adequately educated and informed to do so.

What is an epidural and how common are they?

Dr. Leonard J. Corning, a neurologist in New York, was the first physician to use an epidural. In 1885 he injected cocaine into the back of a patient suffering from spinal weakness and seminal incontinence.

Today, epidurals are by far the most popular method of pain relief during labor in U.S. hospitals. According to the Listening to Mothers II survey (2006), more than 75 percent of women reported that they received an epidural, including 71 percent of women who had a vaginal birth. In Canada in 2005-2006, 54 percent of women who gave birth vaginally used an epidural, and during those same years in England, 22 percent of women overall had an epidural before or during delivery.

In an epidural, a local anesthetic – still derived from cocaine – is injected into the epidural space (the space around the tough coverings that protect the spinal cord). Epidurals block nerve signals from both the sensory and motor nerves, which provides effective pain relief but immobilizes the lower part of the recipient’s body.

In the last decade, a new type of epidural has been developed (called “walking epidurals”) that reduce the motor block and allow some mobility.

Spinal analgesia (a.k.a. “spinals”) are also used for pain relief during labor, but unlike conventional epidurals, they allow women to move during labor. In a spinal, the analgesic drug is injected directly into the spinal space through the dura, producing fast-acting, short-term pain relief.

Epidurals have significant impacts on all hormones of labor

In the last article, Natural Childbirth IV: The Hormones of Birth, we discussed the exquisite orchestration of hormones during birth and the risks of interfering with the body’s natural hormone regulation.

Unfortunately, epidurals interfere with all of the hormones we discussed.

They inhibit beta-endorphin production, which in turn shuts down the shift in consciousness (“going to another planet”) that characterizes undisturbed birth.

Epidurals reduce oxytocin production or keep it from rising during labor. They also blunt the oxytocin peak that would otherwise occur at the time of birth because the stretching receptors of a woman’s lower vagina (which trigger the peak) are numbed.

As Dr. Sarah Buckley explains 1:

A woman laboring with an epidural therefore misses out on the final powerful contractions of labor and must use her own effort, often against gravity, to compensate for this loss. This explains the increased length of the second stage of labor and the increased need for forceps when an epidural is used.

Epidurals have also been shown to inhibit catecholamine (CA) production.

Remember that CA can slow or stop labor in the early stages, but it promotes the fetus ejection reflex in the second stage of labor. Thus inhibiting CA production may make delivery more difficult.

Epidurals limit release of prostaglandin F2 alpha, a lipid compound that stimulates uterine contractions and is thought to be involved with the initiation of labor. Prostaglandin F2 alpha levels should naturally rise during an undisturbed labor. However, in one study women with epidurals experienced a decrease in PGF2 alpha and a consequent increase in labor times from 4.7 to 7.8 hours.

Epidurals interfere with labor and have side effects for mothers

Epidurals have been shown to have the following effects on labor and laboring mothers:

One important thing to note about these studies: in most of them, the women in the “control” groups were given opiate painkillers, which are also known to disrupt the natural hormonal processes of birth. We can assume, then, that a comparison of women using no drugs during labor would have revealed even more substantial differences.

Epidural also have side effects for babies

It’s important to understand that drugs administered by epidural enter the baby’s bloodstream at equal and sometimes even higher levels than those present in the mother’s bloodstream.

However, because babies’ immune systems are immature, it takes longer for them to eliminate epidural drugs. For example, the half-life of bupivacaine, a commonly used epidural analgesic, is 2.7 hours in an adult but close to 8 hours in a newborn. 2

Studies have found detectable amounts of bupivacain metabolites in the urine of exposed newborns for 36 hours following spinal anesthesia for cesarians.

Some studies have found deficits in newborn abilities that are consistent with the known toxicity of drugs used in epidurals.

Other studies have found that local anesthetics used in epidurals may adversely effect the newborn immune system, possibly by activating the stress response.

There is evidence that epidurals can compromise fetal blood and oxygen supply, probably via the decrease in maternal blood pressure that epidurals are known to cause.

Epidurals have been shown to cause fetal bradycardia, a decrease in the fetal heart rate (FHR). This is probably secondary to the decrease in maternal CA caused by epidurals which in turn leads to low blood pressure and uterine hyper-stimulation.

Epidurals can cause maternal fever, which in turn may affect the baby. In a large study of first-time moms, babies born to mothers with fever (97% of whom had epidurals) were more likely to be in poor condition (low APGAR scores) at birth, to have poor tone, to require resuscitation and to have seizures in the newborn period, compared to babies born to mothers without fever.

Older studies using the more exacting Brazelton Neonatal Behavioral Assessment Scale (NBAS, devised by pediatricians) rather than the newer, highly criticized Neurologic and Adaptive Capacity Score (NACS, devised by anesthesiologists – can you say “conflict of interest”?) found significant neurobehavioral effects in babies exposed to epidurals.

In one such study, researchers found less alertness and ability to orient, and less mature motor abilities, for the first month of life. These findings were in proportion to the dose of bupivacaine administered, suggesting a dose-related response.

Epidurals may interfere with mother-baby bonding and breastfeeding

Some studies suggest that epidurals may interfere with the normal bonding that occurs between mothers and babies just after birth.

In one study, mothers given epidurals spent less time with their babies in the hospital. The higher doses of drugs they received, the less time they spent.

In another study, mothers who had epidurals described their babies as more difficult to care for one month later than mothers who hadn’t had an epidural.

It’s important to note that neither of these studies prove that epidurals were the cause of the behavioral changes observed. However, if epidurals were at fault, the effects are most likely caused by their interference with the natural orchestration of hormones we discussed in the previous post, and may also be influenced by drug toxicity and the complications associated with epidural births: long labors, forceps and cesareans.

There is also evidence that epidurals may decrease breastfeeding efficiency.

In one study, researchers used the Infant Breastfeeding Assessment Tool (IBFAT) and found scores highest amongst unmedicated babies, lower for babies exposed to epidurals and IV opiates, and lowest for babies exposed to both.

A large prospective study found that women who had used epidurals were more than 2 times as likely to have stopped breastfeeding by 24 weeks compared with women who used non-pharmacological pain relief.

Conclusion

Epidural analgesia is a highly effective form of pain relief and a useful intervention in certain circumstances.

However, epidurals and spinals also cause unintended side effects in both the mother and baby, and interfere with the natural birth process and bonding between mother & baby.

In some cases epidurals may be beneficial, but the evidence suggests that they should not be used as routinely as they currently are in the U.S. and other industrialized countries.

Articles in this series:

  1. Buckley S. Gentle birth, gentle mothering: a doctor’s guide to natural childbirth and early parenting choices. Celestial Arts 2009. pp.117
  2. Hale TW. Medications and Mother’s Milk. 12. Amarillo, TX: Hale Publishing; 2006.

197 Comments

Join the conversation

  1. For all the commenters on this thread…its good to share & read people’s experiences – only if its non-judgemental…Most of the people using Epidural are not shunning natural birth- but so many of the people supporting natural birth are actually being judgemental about people who opt for Epidural – why?

    The very first comment on this article (I realise its 3 years old, but am sure many people will continue to use the argument) states that why be afraid of something natural? By that logic, falling sick & death is also natural – but don’t people fear them?

    And lastly definitely want to thank the commenter “Epidural Guy” for his comments seem to come from a experienced & well-researched place. As someone who has recently found out about her pregnancy, this is something I still want to research into & being able to see all sides of the story definitely helps…..

    • I just want to re-iterate one thing: natural birth is not about the process, it is about the outcome, a healthy child and a healthy mother. You don’t have to please your midwife, obstetrician or anesthetist. Every approach has its risks, and the best way to go is to research the subject of childbirth in detail and decide which way is most comfortable for you. Also, labor is a very dynamic process, so be prepared for things to change quickly.

      • To all you mums out there contemplating natural birth. I’ve had a natural birth by episiotomy with an epidural and I’ve had a c-section. All I can say was that one baby took 20 hours and one took 20 minutes. If you want to enjoy your baby and not remember the trauma and endless pain of childbirth and guarantee your safety (an the baby’s) for god’s sake have a c-section. You wouldn’t have a tooth out would you without an anaesthetic? Natural birth is barbaric

  2. Thank you so much for this information!! This has helped me think things through for whats to come in the next 3 months

  3. I had my son when I was 15 years old. I was in labor for 19 hours before I requested an epidural. The pain of labor for me was so intense and terrifying that it took me 15 more years to agree to have another baby. My son was 9 pounds 14 oz. He was huge. I was able to relax after the epidural and was finally able to dilate. delivered him 1 hour later. I did have to have an episiotomy but I think with as large as he was and as small as I am, At the time 5 foot tall, 110 pounds, small hipped, I wouldn’t have been able to deliver vaginally with out the episiotomy. I will probably request a epidural again if my labor is long, or the baby is very large again. I didn’t have a problem bonding with my son. I don’t have any pelvic floor muscle issues, kegals took care of that. My hospital stay was longer than usually, 5 days, but I went in with pneumonia and didn’t realize I had it as shortness of breath was my only real symptom and that happens all the time in late pregnancy. I didn’t have a problem pushing with my contractions when the time came and he seemed to finally come out after I was able to relax. My uterus is tipped though which may have led to some of my labor complications and pain as well. I think every one is different and feels pain differently because their bodies are different. I wouldn’t have ever agreed to this pregnancy with out the epidural I had with my son. It was already traumatizing enough and painful enough for me to delay having another child 15 years. I don’t care what any one says you do not forget the pain of labor. It was indeed the worst pain I’ve ever felt in my life, still to this day. And was in a major car accident 5 years ago with several broken bones and bad head injury that I now get chronic migranes from. I shudder and cringe at the thought of going through labor and delivery again in 5 weeks.

  4. Such a wonderful post, I gave birth to my son naturally and it is such a wonderful feeling, to feel everything that is part of nature. I recommend all future mothers to go natural, and most importantly breastfeed! my son is 11 months now and is still breastfed and the bond between mother and baby is so wonderful and strong!

    • Not everyone can have a natural childbirth. I had to be induced at 40 weeks. The fluids protecting my son were low and I was showing no signs of going into labor anytime soon. Thank god I didn’t have a midwife cause it seems all they care about is the natural way and not the health of the baby or mom. None of the women in my family can breastfeed. Our milk doesn’t come in. My son is perfectly healthy. There are millions of ways to bond with your baby, not just by breastfeeding such as feeding your baby with a bottle and changing his diaper.I also had pre-eclampsia, so hospital birth was medically necessary. I did not need a c section, but I was open to it if it meant saving my baby’s and my life. Natural childbirth is great, but isn’t the most important thing to have a healthy mother and baby?

    • I’m tired of hearing how important it is to breastfeed. It makes me feel so inferior and judged because I won’t be able to. I am so upset that I cannot breastfeed, and comments like these only make me feel worse. Like I will be a bad mother for depriving my baby of the benefits. I get it. Those of us who can’t breastfeed get it. Pretty sure anyone looking into formula vs breast is getting it. Those of you who breastfeed should not be telling anyone what to do. It comes off as superiority.

  5. I had identical twins so that was considered high risk, delivered at 37 weeks vaginally but my doc told me it was statistically best to be induced at this time frame with identicals, (mono-di) they didnt even get to the pitocin and I went into labor but I did get an epidural regrettably, because they told me that it did not affect the babies at all and my contractions were crazy- I feel so naive. If there is a next time, at least I will know better. How can the docs tell you that there are no side effects on the baby when that is just not true?

    • Don’t let people trick you into falling for the woo, Twinmom (hey, fist bump: I’m a mono-di twin mom too!). Here’s an article about how epidurals affect the baby–they barely reach the baby at all (most of the medication stays within the spine, and what does get into the blood stream doesn’t cross the placenta in significant quantities). Epidurals also indirectly have BENEFICIAL effects on the baby, by causing dilation of the mom’s blood vessels and thus more blood/oxygen/nutrients etc. to the baby:
      http://www.allaboutepidural.com/2013/epidural-and-the-baby

      What WOULD reach the babies in significant quantities is general anesthesia if you needed a crash c-section and didn’t already have an epidural in place. Both you and the unborn baby/babies would be knocked out by general anesthesia. Since you never know in advance which vaginal delivery is going to go south and require an emergency c-section, IMHO it makes more sense to have the epi in place so that at least you won’t need general anesthesia.

  6. Hi Chris
    Does C-sec with injection causes pain after so many year for child birth??..I had C-sec because my son swallowed meconium. he was born on 2010..but now I am feeling the pain in my back where injection was given.I didn’t get much chance to rest, since I didn’t had any help…what could be the reason for my pain?

    • The injection is given in your lower back. Lower back pain is very common as people get older, and especially after pregnancy/childbirth (because pregnancy and then carrying babies/little kids around is very hard on the back). Assuming you didn’t get a catastrophically badly done epidural (which you would know if you had), it has nothing to do with whether you got an epidural or not.

    • Hope you get this since last post was 2014.
      Please look up arachnoiditis.
      If you are still in pain and can have mri get one with dye. Regular MRI’S miss arachnoiditis a lot of times. Hope this finds you in the best of spirits and health.

  7. I have 5kids and 4of them naturally no epidural I had no knowledge of epidurals just knew people got them so they don’t feel contractions I just had my 5th baby on January 06,2014 but my due date wasn’t until the 24th due to very high blood pressure and risk of going into seizure I ended up getting an epidural and boy did I feel like a coward I really tried my best and hardest to go all natural as I did my other births but gave in I can’t argue with the fact that it did help my blood pressure go down a bit and I felt more relaxed at the time that is…. how I came across this article is I’m 3weeks post partum and my back is killing me not a back rub, heat pad, hot shower has helped it 🙁 and I assume it’s because of the dam epidural trust me it is not worth it and I do agree on the breastfeeding part too because I couldn’t even latch my babygirl on and only ended up breastfeeding 2days and stopped do to tore up nipples it broke my heart that I wouldn’t be able to share that bond with her I get teary eyed bc of it I wish I would have done more research on epidurals but whats done is done dam blood pressure!

    • Unfortunately this is a natural reaction, to connect whatever problem after labor with epidural. You had complicated pregnancy and – judging by the fact that the pain was considerably stronger than during your previous labors – complicated delivery. Back pain is a very common complication of pregnancy (http://www.allaboutepidural.com/epidural-and-back-pain), and, according to the current clinical evidence, epidural does not cause it. The same with breastfeeding: somehow the problems have nothing to do with complicated pregnancy, high blood pressure or difficult labor, it should all blamed on epidural?

      • What about arachnoiditis?
        If you are the “epidural guy” why not warn of the possibility?
        I will be waiting for your excuse and reasoning.

    • Please look up arachnoiditis.
      If you are still in pain have a mri with dye. A mri without dye will most likely not show arachnoiditis.

  8. I completely disagree with some of these comments, even the ones of people who have been through it, or seen it for years. Especially the one who said a mother can completely stay still for an epidural but are wiggling all around during all the other contractions. First off, maybe for some women it is mental or visual, that when they see it they focus on it etc. I tried natural birth. I was teaching yoga all until I went to the hospital thinking “I got this”. After 12 hours of breathing through the very intense contractions that were only getting worse I was completely depleted of any and all energy I was using through that whole time. I was told I only was 4 cm. I opted for the epidural and any other medication until the epidural got there. I didn’t need to look at the monitor because the pain was very real. Yes I was able to muster up all the energy I could to stay still for that epidural because A. I needed it to work, and B. I did not want to be crippled or have some horrible outcome if I moved. That does not mean I could have stayed still and endured countless contractions. That means for that moment I used all I had. Yes there is mind over matter, but for how long. The body can endure a lot and I know I overcame so much, especially through my yoga practice. I come to love overcoming pain. But my mother warned me. She had 3 horrible painful deliveries and said I was crazy to think I was not going to experience the same. She need blood and was hospital bound for a week after my sister. My brother, her last child, was the easiest for her, but still a horrific painful experience. My cousins wife barely made it to the hospital before giving birth to her second son. For her it was very easy. I think all our bodies are different and the birth different. I had 3 births so far and all pretty different. My threshold for pain is at 4 cm. After that it is horrifying. I asked for less of a drip on my son (the 12 hour natural labor described above) and as I was about to give birth to him finally after 18 hours, I felt it and it was terrifying, even with epidural drip. I commend the women that can do it but don’t think all of us can. I’m sure for every story that someone says they did it naturally, another person almost died or did die giving birth. Don’t knock us that need it.

    • Agree with you. Its modern day people choose epidural more than go with natural birth. If it something could risk yourself giving birth on natural why should pushing yourself to go with that way. Some people have some different labor method that they preferred, and it no one business. Instead of blaming one another on the comment that I read maybe you should just take the knowledge to yourself on what you belief or you not belief. One of friend that I know died from the natural birth due to that her body not able to endure the pain and the giving birth is not something you can judge people decision. No hurt feeling I just said the right opinion that I think is positive. People out there whatever you think what is right for yourself you don’t have to argue someone else opinion. Just waste your time. It not your business in life. Thanks. I’m so sick of people argue with one another for some random discussion/info about things!

    • I totally agree, and I’m sorry you had to go through that much pain. We are all different and it’s kind of obnoxious for anyone to go around saying “Women in labor don’t need epidurals! Med-free is the only way to go!” There is NOT only “one right way” to have a baby! Some women do need epidurals. Several women I know say their labors were stalled by sheer exhaustion until they got the epidural, which let them rest for a little while without pain, and then they were finally able to push.

    • If laboring with working epidural was terrifying maybe elective cesarean is a better option for you. Compared with vaginal delivery in terms of complications cesarean is pretty much “horses for horses”. I am going to address elective cesarean in the next article on my site. For now it is sufficient to say that it is fairly safe.

  9. I’m a labor & delivery nurse (only 4 years in labor and delivery, so I’m not the most experienced) but I’ve also had 3 children. Women may get angry at me but a lot of it’s in their heads. I don’t mean to say that labor pains do not hurt but I honestly believe the reason they hurt so bad is because when you’re in labor (especially at the hospital) you only focus ON the pain. When you’re in a hospital you’re in a different environment surrounded by strangers and you’re hooked up to a machine that tells you when you’re having a contraction. I’ve noticed that when i talk my patients they wouldn’t seem in as much pain until they’d look at the machine and see that it’s showing they’re having a contraction. They don’t seem to even realize it until it’s pointed out to them and almost all of them decide they want epidurals. They’re freaking out screaming and wiggling around all over the bed because it hurts so bad but once the anesthesiologist gets in there and its told that they have to stay completely still they sure can sit still for the next few minutes through all of those contractions that were too hard to handle before and you know why? Because they’re not focusing on them at that moment. They don’t even move a muscle because they’re focused or scared about the epidural instead of the contractions. With my 3 girls I labored mainly at home with the first one and waited until I was a few hours into labor to go to the hospital because I just didn’t feel like I needed to be there yet. I was calm, at ease and honestly it didn’t really hurt. There were a few moments here and there but I was in my own house, I’d do laundry, clean dishes, I took a shower if it was getting worse and used the shower head to help with back pains and once I felt like it had been long enough I went to the hospital and not to long afterwards I had my first daughter. I got pregnant again only two months after my daughter was born (crazy Yeah I know) and was very shook up about having another baby. When my first daughter was 4 months old she kept getting UTIs very bad and at one point got such a high fever that she even had to be resuscitated so of course I was scared and I wanted to be at the hospital the entire time I was in labor with my next daughter. Maybe it’s just because I was stressed during my pregnancy but I went through hell at that hospital. Unlike at home, I couldn’t do anything to take my mind off the pain. I got to lay down in a bed and think of how much I was hurting and I wasn’t allowed to eat and I had to use the bathroom in front of people I just met so I was not comfortable at all. I got an epidural and had such a hard time pushing because I felt like I couldn’t control myself. Eventually I got her out and she was so tired as was I. I honestly had no interest in her until I took her home and felt better. My third pregnancy I decided I wanted to do just as I did with my first and wait until I was farther along in my labor to go to the hospital and I did so much better than before. I believe through and through that most of labor pain is only worsened by the fact that you sit there and focus on it.

    • Chanel- your comments about mothers not even noticing they’re having a contraction until it’s pointed out to them or that they are able to sit still for the epidural because they’re afraid of it and not really in that much pain- is extremely offensive! I was induced as a first time mother and although my contractions were becoming painful I opted to have my water broken before deciding whether I wanted an epidural or not, and the very instant they broke my water I had a contraction and it was so incredibly intense and painful I screamed and was so scared because I knew I couldn’t bare those contractions, there are not words to describe how intensely painful they were, and no amount of distraction would have been able to ease the pain of them, the hospital walls could have been crumbling down next to me and I wouldn’t have cared. Maybe it was the pitocin that made them so horrible, but either way they were unbearable. My anesthesiologist finally came in and when I was told to stay completely still at first I couldn’t, then I had to muster up every last bit of strength, mental and physical, to stay completely still because with as much pain as I was in if I continued having contractions like that I don’t know that I would have been able to maintain my consciousness. So just pointing out that everyone is different and especially as a l&d nurse you really shouldn’t be so judge mental towards others experiences, and at such an important time in their lives it would be awful to have someone on their team who isn’t being supportive.

      • I didn’t mean to offend you! Yes, a lot of women have much worse labor pains with pitocin, and I don’t think labor pains in general are “in their heads” perhaps that came out wrong, but women in hospitals are scared, and let’s face it, nobody likes hospitals. You’re hooked up to all the machines which often times hurts and I think it stresses you out more being in a hospital. I feel bad for the women who need pitocin because from what I’ve seen it hurts them much much worse after they get it. I had a mother who’s labor with her third child was professing very very slowly and the doctor decided to give her pitocin, when I told her the doctors decision she said that she’s always had pretty long labors and that with her daughter she was in labor 17 hours, with her son, she was given pitocin after 7 hours and she said the pain was horrific. She told us she would’ve rather went through the seventeen hours with her daughter again instead of the last 3 hours she had with her son after they gave her pitocin. I’m very supportive of my patients and its definitely their decisions what they want to do. But most of our patients who decide to spend most of their labored at home and then come in once it’s getting time to push have said that it wasn’t as painful as that thought it would be. It’s just a lot easier when you don’t have to sit in a room and focus on the pain, because that can really exacerbate it. All women are different and thankfully we have interventions to help make their labored as enjoyable as can be. I just do feel that if something other than drugs can help than it would be great instead and I’m sorry to hear about your labor pains. Pitocin is very painful, labor is in general of course. When I had pitocin it felt like a little alien was just beating the heck out of my uterus and trying to rip through my stomach lol so it most certainly varies from mother to mother, pregnancy to pregnancy, baby to baby and even hospital to hospital. There’s hospital who have great l&d units, they let their patients walk around, take warm baths, eat, use the labor ball, and there’s the hospital I work at (and had my girls) where the nurses are told not to let the patients out of bed for liability reasons unless they want to go to the bathroom. It’s just so much better when moms have other things to do than sit in a bed the whole time. But if they choose that then they should be allowed. When I was in labor with my second I was so much more comfortable sitting on the toilet, idk why. I didn’t like sitting up in my bed but on the toilet I felt way better but everyone was like “no get back in bed”

        • Who says women in hospitals are scared?!? I felt SO MUCH safer in a hospital than I could possibly have felt trying to give birth anywhere else. It’s so reassuring to know that if anything goes wrong, all the powers of modern medicine will be right there to help you and your baby within minutes.

          If I had given birth at home I would have bled to death. I went into hypovolemic shock and was saved BECAUSE I was in the hospital… and I knew going in that that’s how things worked (i.e. there were doctors there to save me and the babies if things went wrong). It doesn’t get much more reassuring than that.

        • Glad you had such an easy time of it.. I’m currently at the hospital with my wife who has been in labor for 48hrs now with our first child. We labored at home for 8hrs before we went to the hospital for the first time only to find she was a mere 1cm dialated, although 80% effaced. Of course we were sent home.. So we went back to our house and she labored another 14.5hrs with our doula, using all manner of ball, rebozos, showers and baths, lunges and various muscle manipulations. Back at the hospital we found all that work and pain got us to 1.5cm and walking around the hospital for hours. While we didn’t intend to use pitosin or pain medications, her level of exhaustion left us with little choice.. Within 2hrs she has reached 5cm and can finally get some much needed rest so her body is ready to complete the process. I guess she was just a wuss for not being able to labor for days without sleep or food due to the nausea from the contractions. Considering women are already faced with a raft of questions and guilt about how they perform during labor I hope none come across your myopic comments furthering the debasement of their self-esteem.

  10. Please forgive me I left out in my previous comment that I was stuck twice due to the first time was in the wrong spot, or what they said it fell out? I was numb 10 minutes and suddenly thr pain was coming back to the point I was about to faint because of the severity of it. They then inserted another drug realizing it had no effect they then checked my cath and seen it was not in correctly altho I felt the cold sensation of the drug being injected it didnt numb. So they re-stuck me. The pain was so extreme I was all for it. But sadly I do have regrets.

  11. Thanks for this article,
    I am for natural child birth, however with my 2nd delivery I was induced with pitocin it was extermely painful after several hours I requested the Epidural due to the immense pain. My first was painful yet nothing compares to artificial oxytocin. Labour lasted into 20 hours fully numb waist down. After pain staking hours I felt the baby drop and 2 pushes she arrived into the light. No ripping in the vaginal tissues no complications. From my own opinion the labour was prolonged due to already needing to be induced I was42 weeks already. Having the pitocin was the worst and epidurals are almost a must, having natural contractions produced by oxytocin are much easier to endure thus leaving it easier to birth without Epidural. As agian my own opinion I admit since the epidural and delivery I havent been the same, back pain, and bubbling fluid drain down from the base of my skull down the neck with severe migraines/vision problems. Is this related? So for next time I may seek other alternatives to having the “Epidural.”

  12. First of all, Mr. Kresser, thanks for your article and talking about this important topic.

    I have found this article that compares several studies about the impact of analgesia, specifically epidural, in labour:
    http://bja.oxfordjournals.org/content/105/suppl_1/i50.full

    The article concludes that epidural increases labour duration and risk of instrumental vagina delivery. On the other hand, it concludes that the risk of C-section does not change between natural labour and epidural labour.

    The article specifically mentions the Thorp article you refer to about the increase of C-section risk and points out several flaws in its methodology. I therefore would not use such a reference in your article without saying it’s controversial, when there are many other studies that do not show this tendency… Your article is well written and well-informed, and it’s a pity to have such an obvious flaw in it, and it can feel misleading to an objective party.

    (and now, my anecdotal evidence)
    I was recently (5 days ago) father of a beautiful girl. My wife initially requested epidural or analgesics, but finally went without it when they told her labour was going to be quick and the midwifes gave her the option not to take analgesics. She is very happy she did without, even though the pain was obvious and she had to endure the painful contractions, specially the last 1,5 hours.
    About her experience, she said she was more in control of the contractions and the urge to push and probably that was the reason she did not tear. She has recovered very quickly in just a few days and the baby was active and bonding with us from the very first minute.
    I myself was more in favour of a natural birth, but never told her as I wanted her to be fully in control of her birth plan without needing to please anybody else but her, as she was the main actress of the experience.

    Again, thanks for the article and hope to see more of these coming.

    • The use of Thorp’s original article is very common – obviously, for the purpose of scaring women away from epidurals. Which is a pity, because Thorp himself is a very professional researcher: in 1998 review he addressed the flaws of his earlier works and, based on the data available at the time, came to the conclusion that epidurals do not increase the risks of cesarean. Curiously, his initial work got stuck with midwives until today.

  13. This goes to show you, don’t believe every cute doctor picture/blog posted on the internet….

    YOU ARE INCORRECT ABOUT SPINALS….

    Spinals (spinal anesthesia) does not allow motor movement. That is why they are used during c-sections, when you want the patient immobile and pain-free for surgery. The do provide fast-acting analgesia and immobility, however the general dose given for a c-section will last 8-12hours, not something I call short-term. You will be able to lift you legs with an epidural, NOT WITH A SPINAL.

    I was interested in reading this article as a pregnant women about to give birth any day now, but as an ANESTHESIA PROVIDER I do not believe a word you say anymore after reading how incorrect you are on the basics.

    WOMEN GOOD LUCK IN WHATEVER YOU DECIDE. CHOOSE MEDICAL JOURNALS WITH FACTUAL STUDIES FOR YOUR “DOES WORK/DOES NOT WORK” STATEMENTS.

    I PLACE EPIDURALS, BUT MAY NOT USE ONE MYSELF FOR LABOR. ALL WOMEN SHOULD CHOOSE WHAT THEY WANT FOR THEIR BODY AND THERE IS NO SHAME IS WHATEVER YOU CHOOSE!

    FOR THE RECORD: The Adult Spinal Cord ends at L1 and then what is below is known as the “horse’s tail” of nerve fibers. THERE IS NO RISK TO PUNCTURING THE SOLID SPINAL CORD WITH A NEEDLE DURING SPINAL OR EPIDURAL PLACEMENT AT L2-L3 OR L4-L5 BECAUSE THE CORD IS JUST NOT THERE, IT’S THE NERVE FIBERS “HORSE’S TAIL” THAT THEY ARE BATHING IN THE ANESTHETIC SOLUTION. ***ONLY EXCEPTION IS IF THE MOTHER HAS A TETHERED CORD, BUT THAT SHOULD BE IN HER HISTORY FROM CHILDHOOD***

    *SOAPBOX COMPLETE*

    • I wonder where you got your information. Let me address every point of your post.

      1. The density of sensory and motor block is dose dependent. In my practice I do lots of combined spinal-epidural blocks in labor. Spinal bolus consists of 1.5 ml of 0.2% Ropivacaine with fentanyl. Ropivacaine at this concentration does not cause significant motor block, and the woman is able to move her legs comfortably. Spinal dose for cesarean section, on the other hand, is achieved by 2.5 ml of Bupivacaine, which indeed produces dense motor block. Similarly, epidural with high concentration local anesthetic will produce dense motor block (some anesthetists prefer doing epidurals for cesarean section, not spinal, to have the option of extending the block if necessary).

      2. The block lasts for up to two hours, not twelve. anaesthetists know this very well, because when caesarean takes longer than the usual 45 minutes the block starts to wear off and the patients starts feeling pain. In this situation we usually convert to general anesthesia.

      3. Integrity is another issue. The proof of mine: I gave my wife spinal anesthetic for her second caesarean. She is still married to me (that proof that everything was ok).

      4. In the vast majority of people spinal cord does end at L1. True, aberrant variants are possible, and often it is not possible to know about it before giving spinal block. However, touching the spinal cord with the needle produces such sharp pain that the woman literally jumps off the table, and the probability of seriously damaging the spinal cord is low. In my twenty years of practice I have not come across a patient with the spinal cord longer than normal. Still, direct injury to the spinal cord with spinal and epidural needles has been described, but it is very rare: http://www.allaboutepidural.com/can-i-get-paralyzed-from-epidural

      One statement I wholeheartedly agree with: women should choose what they are comfortable with. That is why: educate yourself, find out more about your options, risks and benefits of every intervention. It is your body. Avoiding an epidural does not mean you’re doing “well” and getting it does not mean failure. You’re doing well if you leave labor ward with a healthy baby and free of injury.

  14. I just had my first on 09-13-13 the nurses were in shock when I told them I didn’t want the epidural. She obviously didn’t believe me because she asked me to sign off for it and I told them I wanted to go natural. After 7 hours of labor my baby was stresed and I stopped dilating. My obgyn came in and told me I didn’t have a choice because my baby pooped! I cried for an hour before they did the epidural. Even though I had to get it with my first I want to try natural with my second!!!!!

  15. My mother had extremely hard births, to the point where she needed a family member to come in and donate blood. All vaginal. I had my first very young, so of course I had an epidural. Left a horrible taste in my mouth since it seemed I was progressing quickly but pain got so bad and bf was NOT helping that I took the epidural. Right after I fell asleep. I woke at about 8am. Felt between my legs with my hand and it was very sticky and wet. I assumed my water broke. I could not move at all from my chest down. The nurse got loud and angry asking me to lift my leg, and then the doctor told her I couldn’t. They had to lift my limp legs. I pretended to push and had him 28 minutes later. I felt absolutely nothing. But boy did I have a cute little baby. Because of this 10 years later with my second son, I swore on having a natural birth. My mother thought I was crazy and wouldn’t even discuss it with me except to warn me “not to be stupid”. I was a yoga instructor and taught up until the week I had him so I surely had the deep breathing tools, etc. Well my labor started at about midnight, and peaked at noon (12 hours). I thought for sure he’d come any minute. I had absolutely no energy left and the pain was not subsiding but in stead growing much more intense and lasting longer. I looked at my husband who was completely out of it and had no energy left either, but was ready to go to bat at my command. They checked me and I was only 4 cm. There is no way I could have done it!!! I ended up going for all of it. 6 hours later, with an oxygen mask, and completely overwhelmed, tired, and hungry, I finally had my baby. I felt it a little this time. Asked for 9 cc’s instead of 10 dripping. Felt it get worse and worse culminating to the end. There is no way I could have ever endured that pain. My sister had her first son without meds. It was a nightmare for everyone involved. Some people just can’t! Their body is not built in that way to endure it. My cousin’s wife, on the other hand, barely made it to the hospital with her second child and had him immediately and said, “I wish this for every women.” It was that easy for her! I WISH!!!!! I did really well for 12 hours, I will give myself that. I even had a tub in the room and a shower I was going between. What can help me because I am pregnant again and am will to try one more time.

  16. I was a mother in one of the early trials of inducted labour with mobile anaesthesia at Queen Charlotte’s Hospital in London, in 1995. I am still very, very angry, 18 years later. I was over 9 months when they began to induce me with chemicals, but I was a first time mother and I think, had I been left, I would have had the baby on my own. Being brought into hospital in itself, I think, caused my body to shut down. I had three days of labouring to no effect. By the second day my baby turned round in the womb so her backbone scraped against mine. It was agony. I couldn’t rest: I spent that night kneeling against the bed so the weight of the baby moved forward. At one point that night I went to the window of the ward and looked out onto the flat roof where i could see the train running. I actually wondered if I could force open the window, climb out and escape. If I had not been so heavily pregnant that I could no longer climb I would have gone. By the third morning of no sleep I knew I was running out of the energy to give birth. After my husband had argued for a while with the ward sister my waters were manually broken and I was taken to a delivery suite. The pain of the contractions with the baby scraping my spine was excrutiating. I was so pleased to have the epidural, with the drip on wheels so I could go to the loo. And then after hours it came to the birth, and the anaesthetic stopped, and I was told to push, because I had no idea when to push, because all my natural instincts were numbed. It still hurt though. I remember thinking: I hope this is not a girl, I hope that this baby does not have to go through this. And then it was clear she was not coming out. I thought: “I am like a fox caught in a trap, it is as though I have to gnaw my leg off to get free. I just have to push the baby out whatever the pain.” And I did that, despite the lack of sleep ( I was 40 years old), and I ripped from vagina to anus, and the womb itself ripped. I lay bleeding like a slaughtered chicken (my husband’s simile) and heared the doctor say to the midwife: “OK, I’ll stitch the muscle if you stitch the flesh.” It took the two of them an hour to stitch me up. I won’t describe the pain and indignity of the aftermath, and the difficulties it put in the path of bonding with the child who was, greatest of ironies, a girl.

  17. thanks for this article. I had my first two naturally without any pain medication. Epidurals are awfully tempting for our third because I’ve been reading about others who did it that way. But no matter how birth happens, it’s not pleasant at the time and all us mothers share that bond no matter how we give birth. They say it’s like the pain of breaking 20 bones at the same time. But this article has a lot of reasons why going it natural may ultimately be best for mom and baby, despite being much more painful!

  18. I will repeat it again and again: in general epidurals are very safe. Are they 100% safe? No. Epidural can lead to devastating complications, including paralysis and life long pain. On the other hand, the chances of getting these complications are very low. So: do not rely on tales of friends, doctors or midwives, never mind if they are pro or against epidurals. Instead, do proper research and decide for yourself if the risks of epidural are worth its benefits. Facts, not opinions or anecdotes.

  19. I had my first baby without meds, but I was given pitocin after 12h of labour because the baby was fairly big and got stuck, causing the labor to stop. My baby was born after a total of 25h laboring, no epi or pain relief, loads of episiotomy, needles to say, I suffered hell and as far as the pelvic pavement goes, I couldn’t sit for about a month. So far for the natural birth experience. Second time around, I had to be induced because I had gestational diabetes, I was really upset because I was hoping on a totally natural delivery (this time the baby was also average so I hoped the expulsion would create less problems), I ended up asking for an epidural when the contractions became stronger, I just didn’t feel in a brave mood that day. Turns out it was the best decision I ever made: I was relaxed, could stop suffering for a while, I still felt the contractions, especially the very strong last ones, was perfectly able to push through these contractions and it took 40 minutes after the epidural and 5 minutes of expulsion to get the baby out. I will breastfeed for 6 months like I did with my first, and I don’t see why the epi would keep me from loving or taking care of my second child. Actually, because of the great experience I had, I might even consider to have a third child in a couple of years. So actually, I used to defend the naturally in all things and especially in birthing, but not on this very argument, not anymore 🙂