9 Reasons I Chose Not to Get an Epidural

...including Side effects, Catheters, and Control Issues et cetera 

Here is the short version of my 9 reasons not to get an epidural for the birth of my first child:

1. The Urinary Catheter
2. What if it doesn't work?
3. Control Issues
4. For the Experience
5. We've come so far
6. The Natural High
7. Breastfeeding
8. Caesarean Section
9. Cascade of Interventions

Like many moms I thought: 'Will I be able to handle the pain? Why would a woman needlessly and willingly subject herself to the most excruciating torture ever experienced?' 

Good question!

At first the whole idea of an epidural sounds like a win-win-win situation, no pain, no pain and no pain! But no procedure is without risk. Learning about the risks of an epidural helped me make my decision to avoid an epidural as far as possible!

I've heard women say they'd rather give birth than pass kidney stones...

To start with, many women find the intensity of labour is actually not the worst pain in the world, despite what movies would have us believe. I've heard women say they'd rather give birth than pass kidney stones, for example. But every woman's experience is different, and I can only speak for myself and tell you why I decided to avoid an epidural as far as I could.

So, what follows were my reasons for not getting an epi, based on what I knew when I gave birth to my first daughter. There are others, but these were mine at the time:

1. The Urinary Catheter

...because when you're numb from the waist down, peeing by yourself poses a significant challenge.

Do you know how many women are unaware that an epidural is not just a needle in your spine and that's it? The moment you choose an epidural, you need an IV line, if you don't have one already, and you need a urinary catheter, because when you're numb from the waist down, peeing by yourself poses a significant challenge. Yeah, I know they usually only insert the catheter after you're numb, but just the thought of it makes me squirm.

On top of that you have to have a blood bressure cuff, and if you didn't have it already, and an electronic foetal monitoring device, and contraction monitor strapped onto your belly, or placed internally. I mean, are there any other orifices you'd like to invade? I may have one or two left that haven't been poked or prodded in the last couple of hours... So yes, we can have all the studies about side effects and neonatal and maternal morbidity in the world, but this was a biggie for me! So lets count those wires / tubes:

1. Epidural Catheter
2. Urinary Catheter
3. Blood Pressure Cuff
4. IV Line
5. Contraction Monitor
6. Baby's Heart Monitor 

The idea of 6 wires and tibes going into or stuck onto my body was a big part of my decision to exhaust any and all alternatives before resorting to an epidural!

An epidural catheter kit. (Link)
Those stripes on the needle are each 1cm wide.

Besides that, the idea of that big needle burying itself 4-6cm into my spine freaked me out more than the idea of pain did. (To be fair, the needle itself doesn't stay there, but still. For interest's sake, see how an epidural is done here - opens a new window.)

2. What if it doesn't work?

I didn't want to set my heart on an epidural and then have it not work sufficiently, which happens in about 5-20% of women.[1,2] Since I had my first baby a friend of mine had one that wore off as she was just reaching the peak of transition phase, and they generally won't top up the medication at that stage as it is much better for you to have sensation while pushing. She went smack bang into the most intense part of labour without warning and without any chance to stay on top of the pain psychologically or give her body a chance to build up its own endorphins naturally. Not fun!

As a doula I've had clients whose epidurals only took on one side - so they still had full sensation on one side without the option to move around to help relieve the discomfort.

3. Control Issues

Ok, so I am a control freak. Also, I'm a dancer, so my mobility is really important to me. I absolutely hate feeling restricted in my movements. If you were to watch me trying on clothes you'd think I was more than a little strange. I squat, touch my toes, do high kicks, swing my arms, and if I feel too restricted I don't buy the item.

I also dislike getting drunk and the whole idea of ingesting mind-altering substances irks me because I can't stand the thought that I won't be in control. Psychoanalyze me if you like, blame it on the fact that people used to hold me down and tickle me as a child, whatever, but don't give me an epidural! Actually, being a control freak was a major factor in my decision to have a home birth with #2!

4. For the Experience

In all honesty, I secretly wanted to know if I could handle the pain. Some people want to climb Everest, or run a marathon or some other strenuous yet satisfying experience just to have the satisfaction of achievement. So why go look for one, and have to pay for it, when I have a potentially life-altering event barrelling towards me?

My dad summiting Mount Kilimanjaro at age 60...
Maybe being a sucker for punishment runs in the family ;-)

You know what, it was hard work, but I can honestly say that I see the births of my three children - all without drugs, one at hospital and two at home - as three of my greatest experiences ever. They were by no means easy, but it was so completely worth it to be there, fully and wholly there, not sedated or nauseous or dizzy or disorientated as I could have been under the influence of drugs, but really and truly present! The sensation of a baby moving down the birth canal where you can actually feel your child squirming and working with you to be born - that is truly miraculous!

5. We've come so far

I could never understand why I would avoid caffeine, sushi, painkillers, swordfish, hair dye, blue cheese, alcohol and chicken liver pate for 9 months and then pump myself full of powerful drugs that do cross the placenta and have not been tested on babies, without being informed of the risks. It made no sense to me whatsoever, especially considering there are alternatives that don't carry the same risks or side effects. How can you make a choice, and take responsibility for that choice, if you aren't aware of the benefits and the risks of a procedure?

6. The Natural High

Yeah, the epidural can take away the pain, but they don't tell you that it can also take away the pleasure. Did you know in the natural course of labour you and your baby produce beta-endorphins in response to the discomfort experienced? Mom's endorphins cross the placenta as well, so baby gets an extra dose.

When mom experiences no pain as a result of anaesthesia or other drugs, the baby doesn't get those endorphins and it stands to reason that the baby then experiences birth as more traumatic than a baby receiving the full dose of endorphins. Also, as soon as the baby is born and you are no longer in pain, you experience the endorphin rush as euphoria.

The levels of oxytocin in a woman's body in the hour after an undisturbed birth are the highest they will ever be in her whole life. Yes, even higher than they could be after the best multiple extended super ginormous orgasm ever.

An epidural also disrupts the production of oxytocin, known as the love hormone, which is the same hormone that causes contractions, the hormone released in orgasm, and the hormone that is necessary for successful breastfeeding. The levels of oxytocin in a woman's body in the hour after an undisturbed birth are the highest they will ever be in her whole life. Yes, even higher than they could be after the best multiple extended super ginormous orgasm ever. Who would want to miss out on that? Not me!

7. Breastfeeding

Getting an epidural affects your central nervous system. Epidural drugs cross the placenta. Epidural drugs affect your baby's central nervous system. Sucking is a reflex action. A compromised central nervous system can result in a compromised sucking reflex. Compromised sucking reflex impacts breastfeeding success. Capiche?

I wanted to give myself the best chance possible.

Unfortunately, pethidine and other intravenous drugs have a similar effect, so no help there! I was so passionate about breastfeeding that even the thought that the epidural could possibly be related to a decrease in my chances of breastfeeding was enough to put me off completely. [3] I felt that having an AA cup to start with put me at a disadvantage so I wanted to give myself the best chance possible.

8. Caesarean section risk

I was desperate to avoid a caesarean. Epidurals are known to increase the chances of needing a caesarean because of something known as the cascade of interventions. When an epidural is given before active labour starts, the risk of needing a caesarean section more than doubles. [4]

9. Cascade of Interventions

An epidural often slows labour down, so you may need medication (usually Pitocin) to speed things up. Use of Pitocin is known to cause respiratory distress in babies, often causing the doctor to suggest a caesarean section. Even if you don't end up having a caesarean, getting an epidural increases your chances of the baby being in a bad position (because the muscles in the pelvic floor relax too much and you are on your back) and increases your chances of requiring forceps or a ventouse (vacuum) to get the baby out. It also increases your chances of needing an episiotomy, which, like me, you may want to avoid.

Having said all that, if you think I would never get an epidural, you are mistaken. There are times when the risks of getting an epidural are less that the risks of not getting an epidural. (See Use Your Brain for tips on assessing relative risk).

Our bodies produce catecholamines in response to discomfort, stress, bright light and noise. While a certain level is helpful toward the end of labour, when catecholamine levels are too high, labour can be inhibited. Sometimes an epidural can give mom a break so that catecholamine levels can drop and labour can continue.

So while there are other reasons not to get an epidural, these were the biggies for me. Before you get upset with me, I don't judge ladies who do choose to get an epidural, but I do believe that many of them go into it without knowing any of the risks or the alternatives, and then afterwards say they wish they had known. So now you know!

Now that you are considering not getting an epidural, I'm sure you'd like to know about some alternative methods of pain relief! I have a post on that in the pipeline so make sure you subscribe to the blog via email or like our Diary of a Durban Doula Facebook page so you don't miss it when it hits the press!

References:

This is not an exhaustive list - but include the most comprehensive / specific links I could find on each issue.
1. Agaram R, Douglas MJ, McTaggart RA, Gunka V. Inadequate pain relief with labor epidurals: a multivariate analysis of associated factors. International Journal of Obstetric Anesthesia, 2009, Vol 18,10-14.
2. Le Coq G, Ducot B, Benhamou D. Risk factors of inadequate pain relief during epidural analgesia for labor and delivery. Canadian Journal of Anaesthesia, 1998, Aug Vol 45(8),719-23.
3. Riordan J, Gross A, Angeron J, Krumwiede R, Melin J. The Effect of Labor Pain Relief Medication on Neonatal Suckling and Breastfeeding Duration. Journal of Human Lactation, 2000, Vol 16(1),7-12.
4. Klein MC. Does epidural analgesia increase the rate of cesarean section? Canadian Family Physician 2006 Vol 52,419-421.

Hindrances to Natural Birth #37: Mobile Phones

(This is the second post in a series on Hindrances to Natural Birth. The first was a post on how tickets specifically, and time pressure generally, can get in the way of natural birth.)

If you have a mobile phone, cellular telephone, or any other kind of mobile device that you can receive messages on that beeps or buzzes or whatever - then this post is for you.

Even if you aren't pregnant yourself... actually... *especially* if you aren't pregnant yourself - please take note!

Mobile phones can be great. I love my mobile! It helps me keep in contact with my clients, stay on top of emails, do research on the spot, listen to music, take pics of my kids, make to-do lists... I think I'd be lost without it. Mobile devices make our lives easier in many ways - but constant connectivity can have its problems too.

We've read the blog posts about being present in our actual real-life flesh-and-blood lives, we've watched the videos about 'looking up' - that is not everything this post is about.

I can't tell the number of times I have been with a mom resting beautifully between contractions, breathing splendidly through them - serene, undisturbed - and the mobile phone goes off. Buzzing or beeping - both intrude equally on silence.

As if the noise wasn't enough, someone feels compelled to check - to reply - to repeat the question the sender is asking - How far is she? How long to go? How is she doing?

Someone tries to answer the impossible questions - within earshot of a mother who previously was utterly self contained and calm.

'She's only 4cm.'
'It will be at least another 6 hours.'
'She seems to be coping well at the moment.'

Every statement is innocuous on the surface, but carrying an undertone of measuring her up against some fictional standard of how birth happens.

I get that labour can take a long time. It can get boring. Dads can feel awkward and useless in the labour process and checking the news on an iPad helps pass the time.

But like I said in my previous post - oxytocin - the hormone that initiates labour and keeps it going - is a shy hormone. Its release is hindered when a mom feels like her performance is being measured. Those messaging her do so innocently out of concern for the mom and baby. Everyone is understandably excited when a baby is on the way - especially grandparents! But often messages, even the loving and encouraging ones, can be perceived as pressure to do well, to perform.

I know how I am whenever I hear someone is in labour! I'd love a contraction by contraction update. But I also know the possible negative consequences.

Imagine if you had to give a moment by moment update of your honeymoon night... Such an exciting time! A night of new beginnings! Still not keen? I don't blame you.

But what if everyone with an interest in the birth knew that their excitement, and their incessant messaging and even calling could be hindering the mother's intentions for a natural birth? Mothers and close female friends and relatives often bring their own baggage around birth into their interactions with a birthing mom - their own bad experiences, their own cultural anxieties - both of which are unhelpful.  

Every mom needs her team to show their unwavering confidence in her ability to do this birth thing. You are responsible for the energy you bring into your interactions with her. Remember that.

As soon as baby is born, partners are often so busy messaging everyone all the vitals that they can miss out on some of those precious moments of witnessing a baby experience gravity and texture and temperature and light all at once for the very first time.

Image by George Ruiz on Flickr

It's not the partner's fault. He is the link between the mom and the outside world - rather him than her - and there is absolutely nothing wrong with spreading good news! He is meeting all sorts of expectations from family and friends to make sure they are the first to know every bit of progress as it happens. And they have even less of an idea of how long birth takes than he has!

This is a sacred moment. Be there. Whether you send the message now or in an hour's time - it won't make a huge difference to them - but it can make a difference to you and your baby.

Some solutions:

• Set up a messaging group on something like Whatsapp. Any and all labour updates and questions go through the Whatsapp group. No exceptions.
• Warn people beforehand that you will be totally out of contact during labour - and even during the last few weeks of pregnancy - outside of the messaging group.  Set the expectation that you will give information as things happen - no news is good news. When a mom is feeling uncomfortable at the end of her pregnancy, getting 15 messages a day asking her is the baby has arrived yet is just not helpful!
• Set any mobile devices to silent *without* vibration. Check your mobile device/s when it is convenient for you. Make sure technology is your servant and not your master.
• Get a doula. Some partners think that having a doula there will give you less to do, but doulas often help dads to feel far more relaxed and less likely to feel the need to 'escape' into Candy Crush or Minecraft - and doulas help partners to anticipate mom's needs and give ideas on how to help her. Most doulas are also really good at taking pics so dad's hands can be free to help mom.
• Be okay with waiting. Sitting holding the mom's hand for 2/4/10 hours straight may seem boring to you but just your quiet presence can mean the world to her. You only get one chance at this. Be there.

Please share your thoughts and solutions with us!