When it comes to giving birth, one question that really elicits a strong reaction from mothers is whether to have a natural birth or get an epidural.
In this article, we will discuss what an epidural is, why some choose a natural birth, and the risks and advantages of both.
Let’s start off by discussing epidurals, a special type of painkiller favored by pregnant women during labor. Epidurals are undoubtedly the most popular form of pain control during labor, with more than 61 percent choosing an epidural during low-risk vaginal deliveries.
So many women are choosing epidurals. Why? And should you?
What Is an Epidural?
An epidural refers to the process of injecting an anesthetic into the epidural space of the spine to stop pain signals from traveling from the spine to the brain (1). This epidural space refers to the area between the dura mater and the vertebral wall and is typically contains spinal nerve roots, blood vessels, and fatty tissue (2).
When given an epidural, the anesthetic numbs the nerves inside the spine, helping to stop pain from being recognized by the brain. A single shot of anesthetic is normally not enough to last throughout labor, so a thin tube is inserted into the back to deliver more anesthetic medicine as necessary, kind of like your IV.
The Benefits of an Epidural
Epidurals are an effective way to manage pain during labor. Because the epidural blocks nerve receptors and numbs the lower half of your body, the intensity, and pain of your contractions are greatly decreased. For most women, this is the number one benefit of an epidural.
You may not realize there are a few other benefits that occur because your pain has been managed!
Once you get an epidural, you will likely see a decrease in (3):
The Risks of an Epidural
One of the main reasons women opt out of an epidural is because they fear it may harm them or their baby. As with any medical procedure, there are risks associated with an epidural. Once you know the risks, however, you can begin to make preparations to mitigate them.
Some of the most common risks of an epidural include:
- Fever: Women who get an epidural are more likely to have a fever of 100 degrees Fahrenheit or higher during labor. The higher the fever, the lower your baby’s Apgar score at birth, a measuring system for indicating your newborn’s overall health (4).
- Forceps: Epidurals have been linked to an increased need for instrument-assisted delivery. This occurs because it can be more difficult to feel where to push. Forceps and vacuum suction are the most common instruments used to help your baby be born. With these types of deliveries, there can be more trauma to the birth canal, requiring stitches.
- Back pain: Nearly 44 percent of women experience postpartum back pain (5). While you may experience some soreness, there are no studies to indicate an epidural causes serious and lasting back pain after labor.
- Severe headaches: In some cases, the epidural needle can go too deep into the spinal canal, causing spinal fluid to leak. You can get severe headaches if too much spinal fluid leaks out that can last for a number of days. However, this is a rare adverse effect.
- Cesarean sections: One reason epidurals have been so controversial is because some studies have found they can increase a woman’s chance of having a cesarean section (6). However, other, more recent studies refute these claims. At this time, the scientific community has not agreed to the relationship between epidurals and the need for a c-section.
If you are concerned about these risks, talk with your doctor before labor begins. During labor, make sure to communicate with your doctor, midwife, nurses, and anesthesiologist about how you are feeling after receiving an epidural.
Trust your instincts! If something does not feel right, even amidst the pain of labor, speak up.
The Side Effects of an Epidural
After receiving an epidural, you may experience some of the following side effects:
- Dizziness or lightheadedness.
- Nausea or vomiting.
- Difficulty urinating.
- Difficulty moving the lower half of your body.
While these side effects may be uncomfortable or unpleasant, they are not considered harmful and should subside after the anesthesia used leaves your system.
What Is a Natural Birth?
A natural birth can have multiple definitions for different specialists and moms. However, a natural birth generally refers to the process of giving birth without medical intervention of any kind. This means the mom delivers the baby vaginally without the aid of any drug, medicine, or machine.
The Benefits of a Natural Birth
If you are scared of the pain of labor and childbirth, it may be hard to understand how a natural birth can be beneficial. Why would a woman choose to go through so much pain?
The answer is different for each mom, but there are more potential advantages than you may realize (7):
- Control: One of the hardest parts about medicine and intervention during labor is that you lose control and awareness of your body. Moms can find this disconcerting and confining. Labor, as hard as it is, can be a profound and moving experience and some moms-to-be want to remember it and cherish it for what it is.
- Safety: Many moms choose to go the natural birth route to ensure their baby stays safe. Some of the risks of epidurals, as mentioned above, may have a negative impact on your little one. A natural birth eliminates these risks.
- Prevent injury: Epidurals and other pain relievers numb the pain, but that also means you may not feel when you should stop pushing or are pushing too hard. Though the pain may be more significant during labor, post-labor injuries and complications are often prevented in natural births.
- At-home births: Because you do not plan on using the medical services offered in hospitals, you can then choose to have your birth at home in a more comfortable and familiar setting. This can reduce stress and give you more control over your birth environment.
When properly prepared for, natural births can be empowering experiences not only for you, but all those involved.
The Disadvantages of a Natural Birth
The number one disadvantage of a natural birth is pain. A laboring mom can use relaxation techniques and coping mechanisms to manage her pain, but the full force of it will be felt. This can be intimidating and scary if you are not prepared.
Another potential risk is related to natural births that take place outside of hospitals. Mothers who choose a natural birth sometimes choose to have their baby at home or in a special birthing center.
However, if something goes wrong during labor or an unexpected complication occurs, you may be panicked trying to get to the hospital for help (8). If you decide to go with a natural birth, select an experienced and licensed care provider who will monitor your labor closely to ensure you remain low-risk and have a safety plan if something goes wrong.
Epidural vs. Natural Birth: How to Choose
How do you choose between an epidural or natural birth? It can be a complicated question and one only you can answer.
When trying to make the decision, ask yourself some of these questions:
- Is your pregnancy high-risk or low-risk?
- What sort of doula services are local?
- Are birth center or at-home birth services an option in your area?
- What sort of delivery experience does your insurance cover?
- Is there an anesthesiologist at the hospital?
- Have you been sick or injured during pregnancy?
- Are you carrying more than one baby?
- Have you had an epidural or other pain medication before?
- Where do you want to have your child?
- How do you want to care for your baby immediately after birth?
By answering these questions, you will have a better idea of what type of birth experience is right for you and what you want to discuss with your doctor.
Some hospitals have no anesthesiologist and no ability to get an epidural. There are other things that can be done that bridge the gap between an epidural and natural birth that you can talk to your doctor or midwife about if you want something other than an epidural or natural birth.
Editor's Note:Caitlin Goodwin, MSN, RN, CNM
Other Birth Options
If you would like to minimize the pain of labor but avoid an epidural, you have other options (9).
- Nitrous Oxide: A combination of nitrous oxide and oxygen that is inhaled. Some women love this, and some women feel it makes them nauseated, dizzy, or tired.
- Intravenous (IV) pain medication: Giving opioid medications through the IV to alleviate some of the intensity of the labor pain.
- Sterile water injections: Injecting pockets of sterile water under the skin in the back. This works particularly well for those with back pain in labor, like in a baby with an occiput posterior (“sunnyside up”) presentation.
- Hydrotherapy: Warm water immersion.
- TENS unit: transcutaneous electrical nerve stimulation (TENS) unit is a small, portable, battery-powered device affixed to the lower back that provides electric currents that minimize pain.