Do you have a birth plan?
If you are an expectant mother, anxiously awaiting the birth of your child, the answer is likely yes. Whether this is your first child or an addition to an already full and happy home, you can’t help but think of how you would like to bring that child into the world.
Will you be at home or an out-of-hospital birthing center? Will you be at the hospital? Who will be in the room with you?
Is placing the baby on your or your partner’s chest in immediate skin-to-skin important to you? How would you like to be dressed?
These are all questions mothers ask when considering a birth plan. However, one question really seems to elicit strong reactions from mothers — whether to have an unmedicated birth or get an epidural.
We believe all mothers should feel comfortable with their birth plan and remember that all birth plans look different. What is right for one mother may not be right for another. In this article, we want to help you have a better understanding of epidurals and natural births so you can make a decision you feel comfortable with.
I have seen mother’s smile throughout their labor, in seemingly little pain the entire childbirth experience. I have witnessed other women in excruciating pain at about 2 cm dilated. Each women’s labor, pain tolerance, and personal history is extraordinarily unique. It is important to respect one another’s birth plan and recognize that we need to support one another.
Editor's Note:Caitlin Goodwin, MSN, RN, CNM
We will go over what an epidural is, why some choose a natural birth, and the risks and advantages of both. We will also discuss tips that may help you make a more informed decision if you are struggling to determine which is the right choice for both you and your baby.
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 (1).
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 traveling from the spine to the brain (2). 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 (3).
How Is an Epidural Given?
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 procedure may seem overwhelming, but it is manageable if you know what to expect. At first, you will feel a pinching sensation in your back. This is the shot to numb your back so you will not feel the insertion of the tube into the epidural space. As the anesthesia kicks in, the pain should be alleviated and all you should feel is a bit of light pressure. Compared to the pain of labor, the small pricks of the first needle are considered minor by many women.
When Is an Epidural Given?
Anesthesiologists recommend a woman should be in active labor, and in many cases, at least four centimeters dilated before receiving an epidural (4). Outside of those parameters, it is largely due to personal preference.
The sooner you receive an epidural, the sooner the pain will subside. However, doctors can only give you so much medicine and if you get an epidural too soon and the pain returns, you may not be able to receive more by the time labor begins.
You also do not want to wait too long. It is essential that a women is able to sit still in order to receive the epidural, so if pushing has commenced, your body may be too unsteady to get an epidural safely.
When Can’t Epidurals Be Used?
Unfortunately, there are some situations when a woman can’t get an epidural. Pre-existing medical conditions are generally the cause because they put you and your baby at risk for potentially hazardous situations.
You may not be able to get an epidural if (5):
- You take blood thinner medication.
- You have a low blood platelet count.
- You have low blood pressure.
All of these situations can make the effects of an epidural too risky for a laboring mom.
If you have a significant scoliosis or curvature of your spine, it may be more complicated to insert the epidural catheter. Some hospitals also set forth guidelines about how late you can get an epidural during labor. Make sure you share your birth plan with someone else in the delivery room so they can be an advocate for you if your doctor seems hesitant to give you an epidural for any reason.
Are There Different Types of Epidurals?
Did you know there are many different types of epidurals used to treat a variety of back conditions? Of these, there are two main types of epidurals used for moms in labor (6):
- Standard Epidural: This type of epidural relies solely on local anesthetics, such as lidocaine, bupivacaine, or ropivacaine. These medicines have a powerful effect, leading to a completely numb or “dead” feeling in the lower half of your body. Pain is greatly minimized, but it is often difficult for the laboring mom to move.
- Combined Spinal Epidural (CSE): This type of epidural is more commonly referred to as a “walking epidural.” A combination of local anesthetics, narcotics, and epinephrine (a form of adrenaline) allows the laboring mom to have more use of the lower half of her body. Mobility is increased, which helps in the labor process, but the pain relief won’t be as strong.
Understanding how you may want to move about during labor is an important part of your birth plan and can help you decide if an epidural is right for you and what type may benefit you most.
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.
As we discuss the risks of receiving an epidural, you should remember there is a distinction between true health risks and side effects or disadvantages that, while unpleasant, do not pose a serious threat. Don’t worry, though! We will get to those next.
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 (7).
- Forceps: Epidurals have been linked to an increased need for instrument-assisted delivery (8). 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 (9). 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 (10). 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.
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 is 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 (11):
Labor is beautiful, but it is also exhausting and can even be traumatic. An epidural allows a laboring mom to get the rest she needs to push effectively when delivering vaginally. For moms getting a c-section, an epidural allows them to receive a slightly larger dose to remain awake during the procedure.
Most moms who make a birth plan want to remain an active participant throughout labor. Being able to communicate, make decisions, and hold onto the joy of the moment are all heightened when you are not crippled by pain.
Other Frequently Asked Questions About Epidurals
We understand there are so many more questions you probably have about epidurals and how they may affect you, your baby, and your labor experience. While we can’t answer all of those questions, we’ve gathered a few more we feel are important.
Does an Epidural Prolong Labor?
Epidurals can prolong labor. The generally held belief is that your limited movement after an epidural can make it more difficult for your baby to descend into the birth canal and take a good position for birth. It can prolong the first stage, labor, but does generally not prolong the second stage (12).
Anecdotally, some women who are not progressing and struggling with labor may get the epidural and relax. Their cervical dilation will often increase once they are able to rest.
Editor's Note:Caitlin Goodwin, MSN, RN, CNM
Will I Be Able to Push?
You will still be able to push after an epidural. However, because you will have lost a lot of sensation in the lower half of your body, it may become more difficult for you to know when the right time to push is. Your doctor or midwife should help you after an epidural to know when to push.
If you don’t feel a strong urge to push, many clinicians will allow you to “labor down”. This means that you relax with your epidural until the baby descends low enough to give you a strong urge to push. If laboring down doesn’t work, turning down the rate of the medication through the epidural can help you to feel the urge to push.
Does an Epidural Always Work?
Nearly 99 percent of women experience satisfactory pain relief after receiving an epidural. However, some variations may cause an epidural to be less effective. Most of these variations have more to do with the technique and ability of the anesthesiologist, rather than the epidural anesthesia itself (13).
If your labor is going especially fast, an epidural may also not have time to take full effect before your baby arrives.
Do Epidurals Cause Autism?
While some preliminary research supports a link between the anesthesia in an epidural and autism in a baby, there is no known true and proven link between the two (14). Some factors, which are mostly genetic, play a role in your baby’s chance of being born with autism, and epidurals have not been found to change those factors in any significant way (15).
Understanding Natural Birth
In recent years, we have seen the reemergence of natural births in hospitals and homes. More than ever, moms-to-be are opting out of medical intervention and seeking different coping mechanisms for their pain.
There are many benefits to a natural birth experience, but it can definitely be daunting, especially if you are preparing for your first child. Is a natural birth something you should consider?
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 (16). 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 (17):
- 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 (18). 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.
Having a Successful Natural Birth Experience
One of the best ways to ensure you have a successful natural birth experience is to be prepared.
Here are five tips to help you get started.
1. Monitor Your Baby’s Health Every Step of the Way
During a natural birth, you will experience a lot of physical, emotional, and mental stress. The last thing you want to be worrying about is your baby’s health. You need your focus to be on managing the pain and delivering your child.
That is why you must ensure a skilled professional will monitor your baby’s health throughout your pregnancy and labor. This will allow you to get the help you need if it becomes necessary for a doctor to intervene.
2. Practice Relaxation and Coping Skills
Relaxation and coping skills, such as meditation, breathing, and stretching, are popular for natural births because they help manage the pain (19). You can learn many different techniques before labor begins so you have an arsenal of things to try once your labor pains hit.
Do not be afraid to be prepared with multiple relaxation techniques. You never know what might be the one thing to help during childbirth.
3. Create a Soothing Environment
Whether you are striving to have a natural birth in your home or a hospital, do all you can to have a soothing environment.
Postpositive messages or affirmations. Bring pictures of your family. Dim lighting, gentle music, hydrotherapy, and even aromatherapy are some more options you can consider
After all, the labor environment can often become messy and turbulent. Striving to set up a calm place to begin with will help you find some inner peace when the outer world gets crazy.
4. Get Your Partner Involved
Get your partner or a trusted loved one involved and have them use the power of therapeutic touch to help you during labor. A study found 77 percent of laboring moms experienced less pain when touched in a positive way (20).
Positive touch can mean a lot of different things. Your partner could hold you in a comfortable birthing position, give you a backrub, stroke your hair, apply cool compresses, or even learn a few massage techniques.
5. Be Flexible
A birth plan is a great thing to work toward, but labor can be tricky and you never know what will happen and how you will react. Be flexible and ready to change your birth plan if necessary.
You should not feel shame or embarrassment if you decide you need an epidural or some type of pain medication. It is okay!
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
If you would like to minimize the pain of labor but avoid an epidural, you have other options (21).
- 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.
Your Choice Mama
The goal of all birth plans is to bring a baby safely into the world. No matter what you choose, if you are striving to do what is best for you and your child, then feel confident in it!
We want to know which you are planning on choosing or what your experience was like with either an epidural or natural birth. What tips would you have for a mom-to-be trying to create a birth plan?
After all, labor is a unique event only a woman who has gone through it can truly understand. Let’s share together as a tribe of mamas wanting to ensure this special time is as positive as it can be for every woman facing it.