Wednesday, July 20, 2011

A Surprising Downside of Epidurals

Epidural anesthesia remains the most popular form of pain relief in labor. Nurses, physicians, and many midwives like epidurals because the mother is comfortable and quiet, resulting in less work for hospital staff.

Laboring women like epidurals because they can remain awake and alert, while feeling little or no pain during labor.

Many negative aspects of epidurals have been debated among researchers. Downsides to epidurals reportedly include delay in labor, increase in vacuum/forceps deliveries, and increase in c-sections. But aren’t these possible side effects outweighed by the positive effect of a pain-free labor?

In one research study, investigators found that women who had pain eliminated during labor still reported that they suffered! Concluding that no pain did not necessarily mean no suffering, Wuitchik¹ emphasized the need for women with epidural anesthesia to have continual labor support available. In this study, women described distress over itching, numbness, and nausea–all side effects of epidural anesthetic. The women also reported concern over the baby’s well-being. A common effect of epidurals is a prolonged drop in the baby’s heart rate. While hospital staff may take this in stride, it can be very frightening to the laboring woman. Another interesting finding was that women reported feelings of incompetence and fear over being left alone once they were “comfortable”. Wuitchik concluded, “With epidurals, pain levels were reduced or eliminated. Despite having virtually no pain, these women also engaged in increased distress-related thought during active labor. The balance of coping and distress-related thought for women with epidurals was virtually identical to that of women with no analgesia”.

Women who had epidurals expressed just as much need for continued support as women who had unmedicated births, concludes another research study.² In fact, satisfaction with the support received during labor had more influence on the woman’s satisfaction with her birth experience than her level of pain relief did, according to Mother-Friendly Childbirth — Highlights of the Evidence.

If you are planning an epidural, or even if you are not planning an epidural but plan a hospital birth — do yourself a favor and hire a doula for continuous labor support. It can make a huge difference in your satisfaction with your experience. I think the fact that continuous support influenced birth satisfaction more than pain relief explains why many studies conclude that women who had unmedicated births (most often these are women who have doulas and/or midwives during labor) were happier with their experiences than those with medicated births. It’s not the medication or the absence of medication that made the difference, but the presence of someone there to give continual support. A partner may give excellent support, but partners need support, too! Partners get tired, need to eat, go to the bathroom, get discouraged, just like laboring moms do. A doula is there for both of you, and a good doula will give you your space when you need it, time for just the two of you when you need it, yet be there with just the support you need at the right moment when it is needed.

1. Wuitchik M, et al. (1990) Relationships between pain, cognitive activity, and epidural analgesia in labor. Pain 41:136-142.

2. Lally JE, et al. (2008) More in hope than expectation: A systematic review of women’s expectations and experience of pain relief in labour.

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