Epidurals

[Rifka]

I never assumed that you didn't read the forum, Sky Bones. I always assume that the writers read the board and take that into consideration when I write here. But, I didn't think you would freak out by my stating that I felt you were a little unecessarily snarky. Was it being rude to state my opinion on that? I even mentioned that you acknowledged that you might have been jumping to conclusions. So, I'm not sure why you seem upset with me. What are you getting at?

[Rifka]

And Hypatia, I know you didn't flat-out say that if you get an epidural, you'll have to get a C-section. But, I thought your explanation could be misleading to some people. I understood that you were showing possibility, but I could see how a person could read it and think that an epidural pretty much destines a woman to have a C-section. That's what I was concerned about.

[Sky Bones]

I'm not sure why you think I'm "freaking out." After all, I'm not the one writing long, ranty postings here. I would just prefer that you didn't label me. Feel free to label my responses with anything you want, but pal, don't call me snarky. You don't even know me.

[Rifka]

I was just wondering why you felt the need to point out that you read this forum. I didn't mean to offend you, though, or label you. I merely meant to state my feelings about that bit of your writing, not about you as a person. Apparently my wording there wasn't as clear as I thought. And just for the record, I actually thought your piece about your experience with unmedicated birth was very well written.

[Sky Bones]

Thanks. I wasn't trying to egg you on, I promise. Maybe I did misinterpret your post a bit then, because it seemed to me like you were saying things specifically about me, not my response. I just wanted to make sure you were aware that I am usually around despite my lack of posts. You seem to me pretty involved in this topic and I just wouldn't want you to say something you might regret later... really, that's all.

[Rifka]

No problem, Sky Bones. I really just meant to comment on what you said, not on you personally. I think I misinterpreted you a bit, too. This thread topic is one I feel strongly about and upon re-reading all the answers today, I realized I might have read a bit too much into them. I'm still glad for the discussion that's gone on about both sides of this issue, though. It's been interesting to hear more about the different viewpoints.

[Hypatia]

Although I'm sure this is going to reignite whatever issue is going on here, allow me to remind Rifka that the question was "why do women advocate natural childbirth?" Therefore, putting in information and praise for medicated childbirth was tangential and unnecessary.

Prediction for the future of this thread:
Rifka - A;OSIDRLDKFASOEIUROAWLSIJFOASIDJVALSEOFIR YOU WRITERS ARE SO SNARKY!!
Some other writer: Wow, way to say thank you to someone doing a service.

[Craig Jessop]

Although I'm sure this is going to reignite whatever issue is going on here, allow me to remind Rifka that the question was "why do women advocate natural childbirth?" Therefore, putting in information and praise for medicated childbirth was tangential and unnecessary.

Prediction for the future of this thread:
Rifka - A;OSIDRLDKFASOEIUROAWLSIJFOASIDJVALSEOFIR YOU WRITERS ARE SO SNARKY!!
Some other writer: Wow, way to say thank you to someone doing a service.

You forgot something:

Other non-writers - Yeah! The writers are snarky!

[TheHaters]

I'm so proud.

[bobtheenchantedone]

Considering both Rifka and Sky Bones have already calmed down, I think you're more rehashing the thread than predicting the future, Hypatia. Thanks for trying to inflame things again...?

[Marduk]

More to the point: this thread has organically moved beyond the original question, which as Hypatia pointed out, was about advocating natural birth. I for one would like to see this thread morph into a discussion on the pros and cons of each.

Ready, go!

[Dragon Lady]

Hmmm… interesting. This is how I see it, but I don't believe my list to be complete.

Natural Childbirth
Pros
- You are more in control. You get to make more of the decisions.
- You don't have to labor on your back, which, btw, is the absolute worst position to labor in.
- You can walk around during labor.
- You can labor in water.
- You can feel when to push instead of relying on a doctor/nurse looking at a monitor to tell you when and how long. (This is my my mother hated the one epidural she got.
- It builds a confidence in yourself and your body's natural abilities. (So does pregnancy, btw, but this adds to it.)
- You're not numb afterwards.
- You're less likely to tear, because you can feel what's going on, where it hurts (and thus is likely to tear) and can support your perineum in the right places through crowning.
- There is a natural high afterwards. (This may be true of other methods, but I have no personal experience with them.)
- You have more options as to where to labor.
- If you choose to labor outside of a hospital, you can eat real foods! (I'm not kidding when I say this is one of the main reasons I'm seriously considering a birthing center next time.)
- You don't have to be stuck in an uncomfortable bed. (Unless you're also getting an IV or are being induced and thus have Pit through an IV. Or unless they're forcing you to wear monitors.) (I'm not kidding when I say that I took more pain meds for my sore tail bone after that awful bed than my tear and another one of my main reasons for seriously considering a birthing center.)
- Your entire pregnancy you worry and fret over what medications you can and cannot take. EVERYTHING says, "Consult your doctor if you are pregnant or nursing." And let's be honest, I don't want to call my doctor every time someone hands me a new kind of cough drop. But when labor comes, the most common thing to do is pump drugs through your body. Pitocin. Epidural. Plus a bunch of others. There is much debate as to whether the epidural crosses the placenta, but generally speaking, babies born with an epidural are much more groggy upon coming out and take longer to figure out breastfeeding. And that makes me give pause to what else it might be doing to those babies. What don't we know yet?
- Much less chance of a c-section (according to some).
- It gives you an amazing feel of accomplishment.
- The feel of doing something the way God intended. (Please don't take this judgmentally. It is an opinion, not a requirement. But it largely guides me and many other women in choices of childbearing, healing, and eating. And probably a lot of other aspects of life. It is a valid reason, but is not intended to be judgmental for those who view it otherwise. It is only a pro for people who think this way.)

Cons
- You don't get an extended break. If you have a really long labor, it's hard to keep up your strength during pushing. Sleep is practically non-existent during the later stages of labor.
- Much more pain. (Unless you're doing something like HypnoBabies. Then it's called pressure. Hahaha.)
- When you get to transition, you're 90% certain to ask for drugs because it's one of the most painful moments and you've been doing it for so long and are just ready to give up. If you do get an epidural (the doc doesn't realize you're in transition, which means it's probably too late for drugs unless you do narcotics), it's probably not going to kick in until it's too late. Also, depending on your state of mind, you're much more likely to feel like a failure. Even for just asking for drugs. Even if they tell you it's too late. (Been there; done that.)
- If something goes wrong that is completely out of your control, it is much easier to feel like a failure. (Been there; done that.)
- If something goes wrong and you have to have an emergency c-section, getting the epidural in is 10 billion times worse because you have to do it in the middle of your most intense contractions. Or you get general anesthesia. And who wants to be unconscious when your baby is born? (Well, during pushing you might rather be unconscious. But you change your mind the second you get to hold your baby.)


Epidural (Note: I have no personal experience with this.)
Pros
- Pain relief!!! (This is probably the main reason people get epidurals.)
- When you're exhausted, you can take a nap.
- In case of emergency c-section, you're already set up and good to go.
- If done right, you can feel pressure and not pain, letting you be more in control of your labor.
- You're already numb, so if you tear or got an episiotomy, you don't need any more anesthetic for stitches.
- … um… that's all I've got. I need someone to shed some light here.

Cons
- Possible risks such as only numbing part of your body or long-term damage such as chronic back pain.
- Lack of control in labor.
- Lack of movement in labor.
- Increased risk of c-section (according to some.)
- More risk of tearing or episiotomy.
- Less control of labor.
- You're numb afterwards.

Obviously I have much less experience with the pros and cons of having an epidural. Someone else who's had one want to chip in? And obviously the pros of one are generally the cons of the other, and vice versa. But it felt silly to list those all out. (Though some are listed in both.)

[Eirene]

Here's an interesting fact that wasn't really pertinent enough to the question for me to include in an answer:
One well-known study (Al-Mufti, 1997) found that 31% of female OBGYNs (in the UK, where they conducted the study) would choose an elective C-section for themselves, even if there were no pregnancy complications or medical indications for one. To be fair, in similar studies in some other countries around the same time period, that number was in the single digits, but really, one out of three would choose an elective c-section for themselves? That is no insignificant minority. And I wouldn't be surprised at all if that number was higher now.

I realize that my opinion on this may change as I go though med school and subsequent training, but I'm really fine with a well-educated patient choosing to have an elective c-section. Yes, it's a big-a surgery, but it's worth remembering that vaginal birth can have long-term, negative complications for mother or for baby.

[Rifka]

Pros and cons of epidurals not already mentioned (From www.epidural.net/pros and cons):

Pros:
-Effective form of pain relief for forceps delivery - particularly for mid-cavity/high forceps procedures such as Keilland's rotation for turning of a baby in posterior presentation.
-Provides effective pain relief after a cesarean section
-Allows mother undergoing cesarean section to stay awake during the procedure.
-Lowers blood pressure, so is very effective for pregnancy induced hypertension.
-May enable a more emotionally positive birth experience if mother's simply cannot cope with the pain.

Cons:
-Mild to very severe, incapacitating headaches (postural in nature) caused by puncture of the dura. About 1%. If this does not resolve naturally in a few days, or fixed with a blood patch, can lead to other problems as outlined in the link above.
-Uncontrollable shivering.
-Ringing in the ears.
-Often causes a drop in blood pressure (sometimes quite dramatic).
-Increase in likelihood of instrumental birth ie, forceps/vacuum suction.
-Increases likelihood of need for augmentation of pitocin as contractions are sometimes slowed down.
-May increase length of labor.
-Block is sometimes one-sided. Rolling onto side where pain is still present often rectifies the problem, otherwise reinsertion or adjustment is needed.
-Sometimes several attempts are needed due to difficulty inserting.
-Occasionally block doesn't take and in an emergency situation, a general anesthesia is needed.
-Being confined to bed with an epidural inhibits an active birth. [Note from Rifka: I have heard of a form of lighter-dose epidural that allows the mother to have relief from some pain, but still be able to walk around. It's not available everywhere, though, and I'm not positive what it's called-- I think it's referred to as a "walking epidural."]
-Inhibits the urge to push and makes pushing very difficult as you are numb from the waist down. It is usually adjusted down or stopped during the pushing stage so you will regain feeling.
-Can cause fetal heart-rate changes.
-Need to be closely monitored, ie Blood Pressure, Electronic Fetal Monitoring, urinary catheter.
-May cause long term backache.
-May cause nausea/vomiting.
-May cause difficulty urinating.
-May cause nerve damage, Arachnoiditis, Cauda Equina Syndrome.
-Very rarely, but importantly, has been known to cause respiratory distress, epidural abcess, paralysis and death.

I tried to look up pros and cons of unmedicated births online, but was having trouble finding a good, reputable website that listed them. I think Dragon Lady did a pretty good job of summing them up, though.

[Hypatia]

One final con to epidurals:

- $$$$

[Carrapicho]

Wow, I didn't check this thread after I posted yesterday, and my goodness, it definitely got a lot of attention! Just a couple of things:

For those on here who have had unmedicated births: I didn't mean to make it sound like I think you feel superior to mothers who elected to have pain meds. I'm just saying I often get that reaction from other women when I mention I had an epidural, especially in the forum/blogging world. These women don't know me--they don't know my circumstances, just as I don't know them. I think most often it's just a case of people being misinterpreted, plus it's often hard to detect tone and/or sarcasm when reading a comment on a forum. Sorry if I contributed to people feeling the need to unnecessarily defend themselves.

Those lists of pros/cons of epidurals definitely sheds some light on what I went through during childbirth. Although I would like to say that, with my epidural, I actually wasn't allowed to labor on my back--I could only lay on the my side because the needle was in my back. That's how I realized I had that one-sided block. I could still feel contractions on my right side if I was lying on my left, and the other way around. Then when it came time to actually push (and I could definitely feel the pressure and it only took about 20 minutes of pushing to get him out), they helped me semi-sit up. I'll never know if I tore purely because I couldn't feel much down there or not.

Honestly, I'd like to maybe try unmedicated with my next one, just to see if I could do it (plus I'd like to not practically faint on my way to the bathroom after the epidural wore off). That's still a little ways away, so I've got time to prepare. Dragon Lady, I'd love to hear about any websites/books that you would recommend, since you seem to have done so much research about it!

[Laser Jock]

One final con to epidurals:

- $$$$

Ah, but don't forget that insurance is necessary before having children, so this probably isn't as big of a factor. (This is a joke. I just thought it would funny if these two highly-argumentative threads cross-pollinated.)

[Rifka]

I'm not trying to fan the flames more, but I went back to my original post and I realized that besides being a little more antagonistic than I meant to, I somehow failed to include the link to the study I referenced about C-sections and epidurals. So, for those who are interested, here's the link: http://www.msnbc.msn.com/id/6980795/ns/ ... -sections/.
I also found this article to be very helpful-- it was published in a journal for midwives, is well-documented, and discusses the controversy over and different studies about whether epidurals lead to increased C-section rates or not: http://midwifeinfo.com/articles/epidura ... a-in-labor.

[Yarjka]

One final con to epidurals:

- $$$$

Okay, someone help me out here: how much do medical bills cost, on average, to have a baby in the U.S. (assuming you have insurance)? We had our baby in Canada, so the idea of paying extra for an epidural just seems very wrong to me.

[Carrapicho]

One final con to epidurals:

- $$$$

Okay, someone help me out here: how much do medical bills cost, on average, to have a baby in the U.S. (assuming you have insurance)? We had our baby in Canada, so the idea of paying extra for an epidural just seems very wrong to me.

Our insurance covered 70% of the cost of childbirth. Both my son and I remained in the hospital for two days after he was born, and our portion came to about $2500 for the two of us for that stay, including all the drugs they gave me before and after his birth. That was just the hospital's portion, though--we also had to pay the anesthesiologist that did the epidural as well as the OB who delivered the baby. Cost for the epidural after surgery was around $400. Cost for the OB was about $1000, I think. We were able to set up a payment plan for all three bills, though that did involved interest (except for the anesthesiologist, which required the bill to be paid in 3 payments and was treated as same-as-cash). I don't know if our situation is close to the average or not, but there's some anecdotal evidence for ya.