Tuesday, September 11, 2007

PSA re: Epidurals

As I prepare for childbirth, I've avoided talking to most folks about my plans. I'm planning to birth at home, and that really freaks some people out. They like to point to the many cases they know of women who needed intervention during birth. But I ask, how often is the intervention needed because of something else that was done....like an epidural? or being forced to lie on her back in bed while she labored? or being stressed out by the hospital environment and all of the strangers sticking their hands up her every few minutes to monitor her "progress"? The statistic that makes me most confident of my homebirth decision is this: worldwide women require a Caesarian section for about 5-10% of births. This includes all women, in all stages of health and illness and complications. But in New Jersey the rate of C-section is over 35% - and most of these women go into labor having had optimal prenatal care and adequate diet. They aren't starving or suffering from malaria or other diseases that complicate labor. That means that just by walking through the door, my risk of major abdominal surgery skyrockets. Add to this the pressure to submit to an epidural, the use of routine episiotomy, monitoring that restricts movement - the women I've known who wanted to birth naturally in the hospital have found it nearly impossible. So why go there if everything is going well?

The women who've had hospital births with epidurals mark me as crazy for planning to labor and birth drug-free. One friend has been fortunate and had pain-relief without any medical intervention or delayed labor - it is possible. But there are so many others who weren't so lucky. An internet search often reveals the possible medical complications of epidurals (headache, back pain, nerve damage, etc.) along with their relative infrequency, but it is much harder to find the larger and more relevant statistics about labor complications, which I've tried to capture here. A word of warning - many reports indicating that epidurals don't cause an increased risk of *insert medical intervention here* are comparing epidural to other forms of medical pain relief, not epidural to non-medicated labor.

It isn't that I'm a fan of pain; it isn't that I'm a new-age all-natural nut. I have decided that a natural childbirth is the way to go because scientific research indicates that labors are shorter and require less intervention when epidural anesthetic is not used. If my labor is somehow complicated, if pitocin is required or a C-section, than I will appreciate the availability of epidural anesthesia. Otherwise, I'll go where billions of women have gone before.

Epidurals eliminate the ability to be upright for labor An upright posture and rocking motions are critical for helping the baby navigate the pelvis.

Epidurals eliminate the ability to be upright for delivery Back-lying positions are much harder for delivery - the baby has to be pushed up hill, and all of the pressure is on the back (bony) side of the pelvis, rather than in the front, fleshy, stretchy side.

Epidurals can slow contractions Because the brain isn't getting the labor pain signals, the force of contractions often slow or diminish. This very often results in the need for medical augmentation (read, Pitocin).

Epidurals decrease mom's blood pressure Combined with back-lying (which compresses major arteries and veins), a decrease in blood pressure can stress the baby - leading to a need to speed up the labor (Pitocin) and/or delivery (episiotomy, forceps, vacuum, C-section).

Epidurals relax the pelvic floor muscles Intact and taut pelvic floor muscles help position the baby's head. If the baby is facing the wrong way, he/she will be harder to push out (in addition to already having to push up hill), and very often results in vacuum extraction or cesarean section.

Women who receive epidurals are much more likely to tear or require episiotomy The vaginal opening is 25% larger when a woman is squatting or forward leaning than when she is on her back. Thus, when on her back something else has to happen to make the opening big enough. Also, rapid extraction by vacuum or forceps inherently damages a woman's body.

This is an excellent collection of information and experiences related to epidural usage in labor: Epidural FAQ. I've tried to find published literature about the risk to mothers from epidural use, but it's hard to find studies that compare epidural births to unmedicated births. The emphasis also seems to be on the outcome of the baby, and the mother's long-term health effects are often neglected. This article suggests that there is an increased risk of C-section after epidural administration, and they do compare to non-medicated births. They also note that doctors who use epidurals in a higher percentage of their patients have a corresponding higher incidence of C-section.

I don't advocate home births for everyone, but I do advocate educated birth for everyone.


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