Get the right information about pain management for labor.
If you’re pregnant, you’ve probably already realized that there are a lot of decisions to make regarding your birth plan. One of those decisions, of course, is pain management – do you want to have an unmedicated birth, or do you want to have an epidural? Do you want to wait and see how it goes?
There’s a great deal of stigma and shame associated with getting an epidural (as there is with c-section, and any other decision made by a person who’s giving birth). But in addition to the false notion that using pain control during labor means your birth wasn’t “natural” or that you didn’t really experience it, there are other ideas about epidurals that people have going into the birth process that impact their decision making. Dr. Edna Ma, a physician anesthesiologist in Los Angeles, says that women often express anxiety regarding epidurals and breastfeeding, concerned that their babies won’t latch on because of the chemicals in the anesthesia, but an October 2017 study negates that. And then there’s the enduring belief that epidurals prolong labor, making it more likely that a person will need a c-section.
A study published in October 2017 in Obstetrics and Gynecology in which 400 women in labor were given either saline or an epidural (neither the women nor their doctors knew who was getting what), found a small difference from dilation to delivery. For women who got the saline, time from full cervical dilation to delivery was 51 minutes, while for those who got the epidural it was 52 minutes. (1 minute might seem like a long time if you’re in labor, but scientifically, it holds no significance.) The number of women who had c-sections in the group was also almost identical, as were other kinds of delivery assistance, like episiotomies and the use of forceps.
So what does this study mean for actual people giving birth, and for the practice of birth medicine? “This is more evidence that epidurals are safe,” says Dr. Ma. “It also carries more weight because it’s in a journal for OB GYNs, and not just anesthesiologists.”
Dr. Ma notes that epidurals can be controlled throughout labor, so if you want to feel more pressure during the pushing stage, the medicine can be regulated to make that possible, and if you want to be able to sleep, the amount of medicine you’re getting can be increased. Once you have an epidural administered, it can benefit you not just for the duration of labor, but also if you need any procedure, like an episiotomy, after labor, and you won’t have to have a local anesthesia applied.
The reasons one might need a c-section, or that labor might be slow, are varied, and have nothing to do with whether or not you have an epidural to deal with pain. Your cervix might not be dilating, or the baby’s head or body might be too large to fit through your pelvis (this is called cephalopelvic disproportion, or CPD). Stress is another cause of prolonged labor. Prolonged labor is defined as labor that lasts for more than 20 hours for first time mothers, and 14 hours for those who have delivered before. If you’re already experiencing prolonged labor, “turning off the epidural won’t help,” the study’s senior author, Dr. Philip E. Hess, told the New York Times.
Dr. Sasha Davidson, a Florida-based OB GYN with training in Maternal Fetal Medicine/Perinatology, says that while the findings of the epidural study are reassuring, there’s some evaluation to be done.
“We have to be mindful of the fact that the study was done overseas, in China, where people have similar body mass index (BMI),” she says. “There are considerations for us as clinicians here – like BMIs, race and ethnicity…not all patients are the same.”
Dr. Davidson is “pro-epidural.” “I tell moms who say that they don’t want one, who think an unmedicated birth means they’re more of a women, ‘It’s okay to change your mind, it doesn’t mean you’re not strong.'”
It’s normal to have concerns about epidurals even if you have read every scientific study and article available about them – after all, it’s your body, your birth experience, and your baby. Dr. Edna Ma recommends explicit communication with your OB GYN and your delivery team. “Have a list,” she advises. “State what you want, what you want to experience.”