Both sides of the epidural debate

Epidural or not? Women share their stories

Omigod, I don’t know if I can do this. There was a point in each of my labours where this thought ran through my mind. With my first child, Paige, this thought occurred 15 hours after being induced, 10 hours after getting an epidural and two hours after I started pushing. I was exhausted. When it entered my mind in my second labour, I had been pushing for about 15 minutes and was just a few moments from delivering baby Zoe — without an epidural. This time the thought came because of pain.

Of course, I did end up delivering and my fears were washed away with the joy of holding my babies. But I learned that choosing whether to have an epidural isn’t just a simple question of pain relief. With Paige, the onslaught of intense contractions due to induction made an epidural almost a necessity. With Zoe, the freedom of walking around the hospital actually helped me deal with the contractions.

There are many aspects of the birth experience that can be affected, positively or negatively, by either choice. Who would know these pros and cons better than women who have experienced both?

First, a caveat: Each of the many women we spoke with had a different experience and a different take. So what you’ll find here is not a definitive answer, but insights that may help you make the right decision for you in the unique circumstances of your labour.

Pain management

Sure, you hear of women whose contractions felt like mild menstrual cramps and who delivered their babies in two pushes. But, really, the mere existence of the epidural is admission that labour is usually painful, and sometimes excruciating. “Every woman reacts differently to labour and stress,” says Isabelle Baribeau, a labour and delivery nurse at BC Women’s Hospital and Health Centre in Vancouver. “Epidurals are a tool — something to assist you. If less invasive methods don’t work, an epidural is an option.”

Stephanie Adams, of Oakville, Ont., delivered her first child, Michelle, without drugs after six hours of labour. “I was able to get through it with breathing in and out,” she says. Labour with second child Sam, however, was a different story. “I thought I wouldn’t need an epidural because I didn’t need it the first time.” But after eight hours of intense contractions, she asked the nurses to call the anesthesiologist. “The epidural worked wonders in the sense that I could relax.”

When Susan Morrison, of Dartmouth, NS, was pregnant with her first child, she knew that the hospital in the town where she lived at the time didn’t administer epidurals, but she thought she’d be fine without one. “I didn’t realize the contractions would be so intense and constant. I did the breathing exercises they taught in my prenatal class. None of that mattered. Demerol made me sick, and the laughing gas was too late to have much effect.”

The needle

While the epidural usually provides excellent pain relief, the process itself gives some women pause. The thought of a long needle inserted into your back can, well, make shivers run up your spine. Add to that the fact that you need to stay perfectly still in the midst of earth-shaking contractions, and you can see why some women hesitate.

While usually the needle is inserted easily with little discomfort, sometimes an anesthesiologist may have difficulty getting it into the epidural space. It was the administration of the needle during her first labour that led Christine Iacobucci, of Newmarket, Ont., to opt for a non-medicated labour with her second baby. “It took repeated tries to get it in.” As a result, her back was badly bruised. “It was more painful than any other aspect of the birth.”

More common side effects are itchiness and shivering after the injection. Says Angie Cossette of Weyburn, Sask., who had an epidural with her first child, Isaac: “The effects felt strange. My legs felt like they weighed a million pounds and I was itchy all over.” (The itchiness may be treated with medication.)

Interventions

Epidurals can increase the need for interventions such as forceps or vacuum delivery, episiotomy and Caesarean section. Michelle Rogers-McEwen of Nepean, Ont., had an epidural for her first labour and says, “When a contraction would come across the monitor, the nurse would have to tell me to push because I was so numb.” This went on for several exhausting hours. “They wheeled me into the OR in case I needed a C-section.” But before going that route, the doctor successfully tried forceps and suction. However, the delivery resulted in considerable tearing and a long recovery.

Sometimes it’s the intervention itself that necessitates an epidural. When Cossette went into labour with Isaac, she thought she might try going without medication. However, she was induced and labour came on fast and intensely: “The epidural calmed me down. I enjoyed the birth experience.”

Baribeau explains that when a woman goes into labour on her own, she tends to progress gradually. With an induction, labour often comes on fast and intensely. That’s stressful to deal with and can quickly lead to fatigue, says Baribeau. “And the more fatigued you are, the less tolerant you are of pain.”

Labour

I remember walking the halls of the maternity ward with my husband for hours during my second labour. The moment I would lie down, the contractions would slow down. I put off the epidural, partly because the pain was manageable but also because I liked not being encumbered by tubes and monitors.

Once you have an epidural, you’re generally confined to bed and hooked up to an IV. And many hospitals continuously monitor fetal heart rate electronically. Anji Sharpe, of Markham, Ont., says of her non-epidural experience: “It was more intimate, no poking and prodding, less invasive.”

However, an epidural can allow you to rest through the contractions. Iacobucci recalls how laid-back she and her husband were after she had an epidural and they were waiting for the pushing stage of labour to begin: “He was eating Indian food. We were relaxed.”

Pushing

Research shows that epidurals can lengthen the second stage of labour. Part of this may be a result of not being able to push effectively, says Baribeau: “In order to push the baby out, you have to be able to feel that you have to push. If you’re very frozen, you can’t feel where to push.”

That was Cossette’s experience. She pushed for two hours with an epidural: “I didn’t know what I was doing with Isaac. I couldn’t feel the need to push.” But her second son, Alex, was delivered after three pushes without an epidural: “I learned to use the contractions. I had better control of my body.”

However, the pain of unmedicated labour, coupled with fatigue, can overwhelm some women. Says Iacobucci, who delivered her second child, Alexandra, without drugs: “I was in so much pain, I couldn’t focus. I wasn’t in control. I lost it.”

Morrison feels that the epidural actually helped her push. “I could prepare myself to push, I could focus more on what I had to do, instead of just managing contractions as I did without the epidural.” And, she says, she and her husband “enjoyed the experience more together. He was a lot more relaxed because I wasn’t in pain.”

Baribeau adds that it’s important for women who have had an epidural to be careful not to overextend their hip joints. It’s a common risk of an epidural because women don’t feel the pain that would alert them that they’re pulling their legs too far back. Cossette, for example, experienced severe pain in her hamstrings for several days after delivery.

Feelings about birth

While the bottom line in childbirth is a healthy mother and child, how a mother feels about the birth experience is important too and can impact her well-being as she heads into the intense job of caring for a newborn.

Morrison’s first labour (no epidural) was so traumatic for her and her husband, David Garlock, that he was reluctant to have a second child. “He didn’t want to see me in so much pain again.” So when they did decide to have another baby, she made sure the hospital administered epidurals and she asked for one right away. “I was more energized in the days afterward. I was a more relaxed new mom.”

Baribeau says that “some women who opt for the epidural feel they have copped out.” Her response? “Regardless of whether a woman has an epidural, giving birth is hard work. The fact that you had a baby, carried it for nine months, that is an accomplishment. You should be proud.”

That said, Baribeau adds that she and her fellow nurses have noticed a look of exhilaration on the faces of women who laboured naturally: “It’s so powerful, it’s hard to explain.” Cossette agrees: “I was elated after Alex was born; with Isaac, I was just zonked out.”

No Comments