Epidural Analgesia—a delicate dance between its positive role and unwanted side effects (Part One)

This is the beginning of a three-part series of posts from family practice physician, pediatrician , neonatologist and Senior Scientist for the Centre for Developmental Neuroscience and Child Health and the Family Research Institute, Dr. Michael Klein, who will share this thoughts and analysis with us regarding epidural analgesia…

A short history of epidural analgesia
It was not until the 1960s and 1970s that epidural analgesia became widely available. Prior to that, anaesthesia services dedicated to the provision of epidural analgesia did not exist. By the 1990s, obstetrical anaesthesia services dedicated to maternity care became common in developed countries.

Prior to the ready availability of epidural analgesia in labour and delivery departments, maternity nurses used their skills to reassure, massage, breathe with the woman through contractions, and employ a range of other methods to handle labour pain. But today, the shortage of staff and the institutional demands on nurses make these skills relatively unavailable. In addition, the education of nurses has taken a more technical turn; the ‘old-fashioned’ skills of hands-on nursing has been replaced, in many educational programs, by teaching technical skills related equipment and medical interventions.

It became clear that to make epidural analgesia reliably available, a dedicated anaesthetic staff had to develop. Once such staffs were in place, there was great pressure to keep them busy. After epidurals became more available, a debate ensued, and goes on to this day, about whether withholding an epidural was interfering with a woman’s autonomy. This discussion did not seem to take into consideration that women might not select an epidural if they knew more precisely how long severe pain would last, or if they understood the benefits and problems associated with epidural use, or if staff were trained in a variety of other effective techniques to assist with the pain of labour. In fact, many women are directly or indirectly pressured into accepting epidurals.

The implications of epidural use
Although it first seemed that epidural analgesia freed up nurses to care for more than one woman at a time, in fact, it soon became clear that the labour and delivery nurse’s time was consumed by the technical requirements of safely managing the epidural and the rest of the technical requirements of her job, leaving little time for hands-on nursing support.(1) A woman who has an epidural requires an intravenous line and continuous electronic fetal monitoring to measure both the fetal heartbeat and the uterine contraction pattern. Because labour usually slows after an epidural, the woman typically requires synthetic oxytocin (Pitocin) augmentation to replace her natural oxytocin production, which is inhibited by the epidural itself. Pitocin can cause painful and very strong contractions: therefore its use requires detailed charting and monitoring for the potential complications of the epidural.

Usually after the introduction of an epidural, a woman has to remain in bed because she cannot feel her legs and she is attached to many wires and lines, so this limits her ability to walk or change position. ‘Walking epidurals’ and telemetry are available only in rare settings and by particular anaesthesiologists. Tethered to intravenous lines and other lines (e.g. urinary catheter, blood pressure cuff,  fetal monitor and the tocometer) and unable to walk, it is almost impossible for the woman to use gravity and different positions to help progress her labour.

The development of new pain management techniques
Prior to the availability of epidural analgesia, the childbirth education movement utilized a variety of techniques that were physiologically and psychologically helpful to reduce pain, such as breathing and imagery. These methods began to take hold in the culture in the 1950s and 1960s but today are less prominent in many childbirth education classes. Some classes are more focused on teaching women compliance with particular hospital technological methods and approaches, routines and policies, rather than on teaching women coping skills.

In the late 1970s and early 1980s, the first studies appeared, showing the value of continuous emotional and physical support by a caring, trained and knowledgeable woman, whose responsibility was to focus solely on the labouring woman rather than on the institution or equipment – the doula. Backed by randomized studies,(2-4) it has become apparent that this emotional and physical continuous supportfrom a doula gives a woman more confidence and ability to work with her labour. All studies to date have demonstrated that hospital-based nurses cannot function as doulas,(5, 6) even if those nurses are midwifery-trained. It is not the fact of being either a midwife or a nurse that matters, but the fact that when these care providers are employed by the hospital, their primary allegiance is to the institution, and they are professionally responsible for the conduct of the labour and the safety of both mother and fetus. A doula who is employed by the woman is responsible only to her. Autonomous midwives in the Canadian context are strongly supportive of doulas, with whom they frequently work in collaboration.

Pain moderation by transcutaneous nerve stimulation (TNS) or intradermal water injections can be very helpful, especially in the earlier stages of labour. Other non-pharmacological methods like water baths or showers or movement, including the use of birth balls, are also helpful for many women who find that partial pain relief is sufficient to help them through contractions. Doula care provides a complementary approach which can reduce the need for an epidural or delay epidural usage until the active phase of labour, when some of the negative effects of epidural analgesia are reduced. In particular, during her labour, doula care and non-pharmacological approaches allow the mother more opportunity to produce her own oxytocin. Natural oxytocin has some important effects: it is the anti-stress hormone, and helps contractions to be more productive; it is also the ‘love hormone’ that later goes on to enhance the bonding process following the baby’s birth—an effect suppressed by synthetic oxytocin, little of which enters the brain of either mother or fetus.

Is epidural analgesia the best form of pain relief?
Epidural analgesia is a very effective form of pain relief, meaning that compared to a variety of other pharmacological and non-pharmacological methods, it provides generally consistent pain reduction. If there were no problems associated with epidural analgesia, almost everybody would want it. Unfortunately, though, associated with its use there are various undesieable effects, including:

  • longer first stage labours
  • longer second stage labours
  • increased incidence of maternal fever directly caused by the epidural, which often leads to the use of antibiotics in both the labouring woman and her newborn
  • increased rates of operative vaginal delivery (forceps and vacuum)
  • increased perineal trauma with and without instrumental births – including severe tears into the rectum (3rd and 4th degree tears).
  • a variety of complications such as a placement of an epidural too high on the spine (leading to breathing problems).
  • failure of the epidural to provide any pain relief, or insufficient pain relief—requiring the continued use of other methods of pain relief
  • increased need for a bladder catheter
  • maternal hypotension leading to worrying fetal heart rate changes
  • an increase in the likelihood of the need for a cesarean section – this last complication being the subject of great debate, which will be discussed further

Of course, some of these problems may occur whether the epidural was or was not truly needed. And when an epidural is truly needed for pain relief or to solve a specific problem, it can dramatically change a situation for the better and can improve outcome. It is only when epidurals are used routinely, and especially very early in labour that these complications are more likely to occur.

Dr. Klein’s next post will take a look at the research on epidurals and discuss the risks and benefits of this pain relief technology.
All references for this post series can be found here: References _ michael klein post.

Posted By:  Michael C. Klein, MD, CCFP, FAAP(Neonatal-Perinatal),FCFP, ABFP
Emeritus Professor of Family Practice and Pediatrics University of British Columbia
Senior Scientist Emeritus
Centre Developmental Neuroscience and Child Health
Child and Family Research Institute
4500 Oak Street
Vancouver, V6H 3N1
Tel: 604-875-2000 ext 5078
Fax: 604-875-3569

Epidural Analgesia, Evidence Based Medicine, Practice Guidelines, Research, Science & Sensibility , , , , , ,

  1. avatar
    | #1

    The epidural has problems, that’s for sure. But it’s still better than twilight sleep, and it’s fantastic for c-sections-far and away better than a general. Are you going to talk about those positives as well?

  2. avatar
    | #2

    “After epidurals became more available, a debate ensued, and goes on to this day, about whether withholding an epidural was interfering with a woman’s autonomy. ”

    Well, of course it would be. Would withholding pain medication interfere with a cancer sufferers’ autonomy? Or would we not even have this discussion?

    “This discussion did not seem to take into consideration that women might not select an epidural if they knew more precisely how long severe pain would last, or if they understood the benefits and problems associated with epidural use, or if staff were trained in a variety of other effective techniques to assist with the pain of labour.”

    Or … they might still go ahead and select it. That’s what really bothers you, I suspect.

  3. avatar
    Rachel H.
    | #3

    He is merely talking about technical problems with epidurals. Every woman should know this before agreeing to it. Its better to know the risks before you get the epidural, rather than finding out after.

    Maybe if more women were confident in their ability to birth, we would have less medical interventions in birth and less maternal deaths.

  4. avatar
    | #4

    @ marth
    soooo if someone told you “you have a 10% chance of causing fetal distress to your infant by selecting epidural pain releif.If the fetal distress persists we would then have to proceed to a major abdominal surgery that has a host of it’s own side effects. However there are other options with fewer side effects you can try first if you’d like.”
    You think most moms and laboring women would still choose the epidural. you really think his qualm is that women choose it at all or that there is no truly informed consent. Do you even know the problems with epidural pain relief?
    The question of the cancer patient is a moot point and do not apply to to this situation as labor is not a disease. Nor a pathologic condition as for example cancer is. End of life care and pain relief are humanitarian measure needed to preserve quality and in a few cases longevity of life where the pain of a possibly terminal illness would do harm to the pt. Physician oath first do no harm.
    Labor is a normal process and epidurals have a high probability of doing harm.

  5. | #5

    @Kimberly, I wonder why people get so defensive about epidurals. The author stated that “And when an epidural is truly needed for pain relief or to solve a specific problem, it can dramatically change a situation for the better and can improve outcome. It is only when epidurals are used routinely, and especially very early in labour that these complications are more likely to occur.” There are times when an epidural can be beneficial, but unfortunately they are used more often than necessary and can lead to a snowball of unnecessary intervention.


  6. | #6

    The problem is that women aren’t told of the harmful effects of an epidural. And perhaps they would decide to go ahead with it anyway. But maybe once they knew all of the harmful things that could come with it, they would make a different choice. The point is, women should be able to make a decision based on the whole truth, not the snippets of truth that the medical industry chooses to reveal.

  7. avatar
    | #7

    Martha, that sounds like a very bitter and nasty response. Pain medication for a cancer sufferer is decided upon in a completely different way, often the medication has side effects, even fatal ones, which are acceptable because of the progress of the disease and perhaps quality of life is more important than length. I suspect most women in labour would not compromise their long-term health for relief of pain that will go away anyway and they would certainly not actively choose to take risks with the life or health of their baby. Birth is not the same as advanced cancer, not the same situation, not the same pain. What do you find so frightening about the information this article presents?

    Kimberly, epidurals good for labour usually require a substantial top-up for a section or a spinal block as well. I wonder if you have the two things lumped together?

    When women are well supported by a midwife or doula they know and trust requests for epidurals drop dramatically, sometimes to zero, and satisfaction with their birth experience increases. That fact alone might suggest that perhaps epidurals are often used as a fix for poor care much more often than they are a fix for truly unbearable pain and fear. There will always be some people who will benefit, there are for any treatment, but often they do more harm than good and I am at a loss to understand why anyone would think that risking harm is or condemning those who want to prevent it a positive way to behave.

    Why are some women so hostile to their sisters who want to birth without cocktails of narcotics and to those professionals who want every woman to have a birth that makes them feel good with as few risks to mother and baby as possible?

    I have had an epidural and I thought it was OK to birth like that, I was happy, next I had a section because birth was difficult and I was told it would be the best way… It was pain-free at the time but it hurt for weeks afterwards. Then I met a lady who introduced me to an ICAN chapter and I started to learn some stuff. I then had a home birth with an amazing private midwife, which was so much less painful than the birth with epidural or the section and I felt amazing afterwards. Like I could climb a mountain or run a marathon, like I could do anything I wanted. If I could choose again it would not be an epidural, it would be good support.

  8. | #8

    Dr. Klein,

    Thank you for your insightful post. Although it is technically an article on the concerns with epidurals (with references, to those who feel his point of view is personal and not evidence-based), the real issue is how it has changed the focus of the primary caregivers in a hospital setting–the L&D nurses. Excellent insight into the way their hands are tied to support women going through a physiological process (nothing like a cancer patient, who sufferes the ill effects of both the condition and the medication) that last for a finite amount of time and are in a very vulnerable, liminal stage between patient and well-person, and between old person and new motherhood. Childbirth cannot be compared to any other experience, and the complications introduced by routine use of epidural anesthesia at the primary way to alleviate pain in laboring women shows a remarkable lack of one-on-one support and dismissal of evidence-based care. Just because we can counteract the side effects doesn’t mean we are choosing the safest thing for ourselves and our babies.

    Thanks for your thoughtful post.

  9. avatar
    Mom of 2
    | #9

    I think our society raises us to think pain=bad and to always avoid pain at all costs. Pain is unpleasant, but it is the difficult things that truly help us grow as people.

    I also have doubts about how much pain epidurals save in the long run. I’ve known many women who’ve torn very badly pushing on their backs because they were numb from the waist down from an epidural. They may not have had pain during childbirth but they were still suffering from it months later. Sometimes with pain, it boils down to: Do you want to pay now or pay later?

  10. avatar
    | #10

    Thank you Dr Klein for tackling this thorny issue. I look forward to what you have to say further. I just did a reunion class last night, and was dismayed when one of the moms said “The nurse told me the anesthesiologist was on the floor about to head into surgery, so if I wanted an epidural I had to have it then or not at all.” Sigh. THAT’s a big part of the problem. And this couple specifically had on their birth plan “please do not offer pain meds, we will ask for it if we want it”. I agree wholeheartedly that it’s not the epidural that’s the problem in and of itself all the time, but when it’s used, and the unnecessary pressure put on a labouring mom!!

  11. avatar
    | #11

    I would not want one even if there were no side effects, not everyone is happy to hop on the epidural bandwagon. I felt this is a very informative article & look forward to part 2 & 3

  12. | #12

    Typo (“undesieable”) here:

    Unfortunately, though, associated with its use there are various undesieable effects, including:

    Would someone go fix that and then delete my comment so I don’t look critical? Thanks. I appreciate Science & Sensibility’s posts.

  13. | #13

    Thank you Dr. Klein! I so appreciate this topic as I have been bothered by the increase in epidural use routinely instead of for specific situations. My coworkers don’t agree with me….. I am looking forward the next posts and sharing them at work.
    I love this excerpt:
    “And when an epidural is truly needed for pain relief or to solve a specific problem, it can dramatically change a situation for the better and can improve outcome. It is only when epidurals are used routinely, and especially very early in labour that these complications are more likely to occur.”
    I agree 200% Seen this unfold in front of me over and over again.
    I also understand the statement about the staff RN… –> “their primary allegiance is to the institution, and they are professionally responsible for the conduct of the labour and the safety of both mother and fetus.” I do agree however I believe in Evidence-Based Practice Guidelines and that is is my purpose to assist the mother and her baby within those guidelines. I also believe in true informed decision making….. and my role to Empower and ADVOCATE for mothers and their babies in my care. I feel that is my ethical responsibility.
    You are correct that in this modern day L&D,(and I’ve worked though 1974 to present)that it’s very technical, very busy and the newer nurses are not even always taught the lost art of hands on nursing support!
    Thank you again.

  14. avatar
    | #14


    The pain of cancer is pathologic. The pain of labor is not. That is the difference when discussing issues of autonomy. Why do people always compare the pain of labor with other pathologic causes of pain? They are not the same and should not be mentioned together. This only causes confusion and blurs the real issue!

  15. avatar
    | #15

    Where are the stats for the likelihood these problems will happen? Having a list of side effects isnt that helpful without being able to put it into context. Bad side effects are very rare, and are more than offset by how well it takes away the pain of labor. And pain in labor should be treated if that is what the woman wants.

    I also found the description of labor before epidurals inaccurate. It wasnt all candy and roses and sweet talk. For a good history of pain relief in labor at: http://www.fathom.com/feature/60992/index.html
    Early feminists fought for pain relief (starting with chloroform) and to be cared for by doctors at hospitals. Years ago, women weren’t considered worthy of a doctors time!  

    The comment on modern nursing was uncalled for. Nursing care isn’t worse now, there are some amazing nurses out there. Some hospitals may be understaffed, but I doubt this is a new problem. The L& D nurses I had were both very caring and available for non medical pain relief support. I had a dedicated nurse at all times, sometimes I had two, and I was just an ordinary patient at a hospital anyone can walk right into. 

    At my labor, all the methods of non pharmacological pain relief were available, as was personal support, but nothing compared to the relief I got from the epidural. And this is the heart of the matter- labor hurts like nothing else for many women, and an epidural usually works great, which is why most women get one. All the support in the world isn’t going to make very intense pain go away like an epidural will. 

    It would be helpful if more hospitals offered the most modern epidurals (the “walking” epidural and the patient controlled epidural, which was great- you could turn it up or down whenever you wanted with a little machine) which solve some of the issues women have with them (too strong, too numb, not strong enough, want to be up walking). I had a patient controlled epidural, and I was able to relieve ALL the pain, but was not numb, could move around and switch positions, and had plenty of feeling for pushing.   

    I also read that epidurals DON’T slow labor when administered after 4 cm, and only slow it half an hour if administered early. And they don’t cause CS either. I can dig up the references if someone wants them.

  16. | #16

    For stats regarding likelihood of stated epidural side effects, check out Dr. Klein’s extensive references list (linked to at end of post). All the data you are asking for is contained there.

    Also, as indicated by “Stork Stories” (see above) Dr. Klein’s discussion of nursing care was in no way an attack on nurses…I believe his points were more in commiseration with L&D nurses: it becomes harder for them to perform the tender patient supportive-type of care when they are professionally obligated to chart readings from fetal monitors four times an hour (or whatever their particular hospital protocol is), rates of epidural infusion, output into catheter bag that often accompanies epidurals, etc., etc. In my interpretation of the post, this is not a criticism of nursing practices, but of hospital protocols that alter how nurses go about interacting with their patients.

  17. | #17

    I feel it pertinent at this point in the conversation to add some additional thoughts regarding Dr. Klein’s following assessment:
    “Prior to the availability of epidural analgesia, the childbirth education movement utilized a variety of techniques that were physiologically and psychologically helpful to reduce pain, such as breathing and imagery. These methods began to take hold in the culture in the 1950s and 1960s but today are less prominent in many childbirth education classes. Some classes are more focused on teaching women compliance with particular hospital technological methods and approaches, routines and policies, rather than on teaching women coping skills.”

    I believe this assessment is definitely true in some scenarios (and more likely so when childbirth preparation classes are taught in a hospital setting) while in other cases…still very much not the case. I believe the issue here is pressure: when teaching courses within an institutional facility (even a birth center, I imagine) childbirth educators will be either required or strongly encouraged to teach what that facility’s administration wants to see taught. (In our local hospital, the six week childbirth ed. classes–taught by hospital L&D nurses–include a mini-lecture by a staff anesthesiologist about epidurals and other pharmaceutical pain relief). According to students I have taught who had previously attended the hospital course, much less time was spent on first and second stage positioning, breathing & relaxation techniques at the hospital compared to my curriculum. Conversely, more time was spent on describing “how birth happens in the hospital.” (These are, by the way, trained and certified childbirth educators.(

    However, my own practice as well as my observations of other private CE’s in my community, reveals that childbirth educators who teach independently tend to have much more control over the curriculum they deliver–including both pharmaceutical pain relief methods, as well as non-pharm pain relief/distraction techniques.

    Just as Dr. Klein spoke of the pressures on L&D nurses to work according to their employers’ requirements, thereby maintaining “allegiance” to the institution which employs them, I believe the same is often true for those who teach childbirth ed. classes in-house.

    Perhaps then, in following Dr. Klein’s descriptions of who provides which types of care, independent childbirth educators can be likened to the doula: providing support (information) to the childbearing woman in a way that demonstrates greater allegiance TO THE WOMAN vs. the facility in which she will give birth. Under this metaphor, hospital-based CEs are likened to L&D nurses (which, in most cases they already are) teaching under the umbrella of imposed allegiance to the institution, which then influences the type and amount of information delivered to the consumer.

  18. avatar
    future nurse-midwife
    | #18

    I can vouch that nurses aren’t doulas. Some of us, myself included, are lucky enough to have cross-trained ourselves, but for many of us, the “natural” methods of pain coping are limited to “Take a deep breath in and when you exhale, feel yourself melting into the bed”. Unless we are interested in the topic and pick up a continuing education topic on it somewhere, or our hospital was particularly natural-friendly, we aren’t likely to know what to do to teach a mom to work with her contractions, nor in many cases, do we have the time to do so.

    It’s not maligning the good work of L & D nurses, it’s just how we are trained.

  19. | #19

    Fantastic resource, thank you. I was hoping to also hear your perspective on the relationships between medical pain management and women with severe anxiety, or history of mood disorders.

  20. | #20

    I really appreciated your reply. It helped move the conversation to considering how and why we distinguish good and bad for our sisters. “Why are some women so hostile to their sisters who want to birth without cocktails of narcotics and to those professionals who want every woman to have a birth that makes them feel good with as few risks to mother and baby as possible?” Indeed.


  21. avatar
    | #21

    I will make this short and sweet. I am a labor and delivery RN in a pretty busy medical center, RN’s are there to support and guide a laboring woman throughout her laboring process, I am sorry to say many woman no longer desire natural childbirth they have all been conditioned to ask for an epidural as soon as the first contraction is felt, they feel as though there should be no pain associated with childbirth or delivery. All of these woman are made aware of the associated risks with epidurals and are all too willing to accept the risks. Contrary to belief epidurals do not slow down labor when a patient is in active labor, an epidural at that time then achieves it’s intended outcome. Nurses many like myself offer and teach patients many other techniques for pain relief, but many are unwilling and don’t care about breathing techniques because it does not relieve their pain. My concern is for my patient and the baby she is carrying not some institutional policy. Regardless of my patient’s choice medicated or not it is my desire for her to have a positive birthing experience.

  22. | #22

    The importance of epidural and other medical interventions cannot be ignored. Thanks Michael Klein and S&S for this paper.
    I have made a few comments of my own at my blog http://villagemidwife.blogspot.com/2011/02/pain.html

  23. | #23

    I would be interested in Dr Klein’s response to this article written about epidurals: http://www.sciencebasedmedicine.org/?p=10765
    The biggest issue to me seems to be access to newer methods of epidural analgesia, which Dr Klein says are only available in rare settings. The above article seems to imply that these newer methods are more widely available and address many of the concerns Dr Klein raises about epidurals. Does anyone have that sort of data?

  24. | #24

    This response is largely a summary of the points made in the book: , Epidural Without Guilt: Childbirth Without Pain, by Gilbert J. Grant. Dr. Grant, an anesthesiologist, selectively uses information that is often unsubstantiated in the literature. Keep in mind that the blogger is responding to Part I. In Part II and III I will address many of the issues covered by Dr. Grant. Basic to much of what Dr. Grant has to say is based on the current Cochrane Review of epidural vs narcotic pain relief. This review, also run by an anesthesiologist, as have all Cochrane reviews on the subject, is deeply flawed. I will cover the details in the upcoming II and III sections.

    A point that comes up over and over again is the idea that withholding pain relief from a process so painful and intense is cruel and inhuman. I do not favor withholding pain releif. There are different kinds of pain relief, and epidural analgesia is only one of them. Well timed and specific to the problem at hand, epidural analgesia can perform admirably. Applied very early and routinely and mindlessly, it can cause problems that might have been avoided. Here the concept developed by Penny Simkin is useful. She makes the clear distinction between pain and suffering. Women who are in pain but are not suffering can be helped by many measures. Women who suffer must be helped by all measures at hand. Suffering is caused primarily by being inadequately supported in labor, by being abandoned and alone, by not having information about how long the pain will last. Suffering caused by intense and unremitting pain must be treated by all means necessary including effective support and epidurals as needed. The claim that early epidurals do not increase the Cesarean section rate is false and will be covered in parts II and III.

  25. | #25

    Thank you Dr Klein, I look forward to sections II and III.

  26. avatar
    | #26

    Another undesired effect of an epidural is that it stops the release of the bodies natural pain relief, which, when allowed to release normally, enable many woman (myself included) to birth without drugs OR pain. It doesn’t have to be a choice between the two.
    The majority of woman in our society have learned to fear birth and are not exposed to positive birth experiences.It is proven that fear actually blocks oxytocin & endorphins (the bodies natural pain relief)creates tension and CAUSES pain (Dick-Reed). Pain is the bodies way of telling us something is wrong- but there is nothing wrong with childbirth, womans bodies were made to birth! so in 95% of cases, birth pain is due to fear-woman who use calming techniques during labour can even birth breech and posterior babies without pain and epidurals. There is no medical need for an epidural- if hospitals spent more money on in depth, positive prenatal classes more woman could experience a positive natural birth without the cascade of interventions that usually follow an epidural.

    For those interested in how fear creates pain:

  27. avatar
    Ruby Osorio
    | #27

    Thank you for your valuable post.

    We have decided to share it with our global physician audience at PhysicianNexus.com: http://physiciannexus.com/forum/topics/epidural-analgesia-a-delicate

    Team Member
    Physicians connecting worldwide

  28. avatar
    | #28

    Hello- I just wanted to note that the references for these articles do not work. I’m very interested in looking at the articles and would appreciate an active link.


  29. avatar
    | #29

    I think it is disappointing when in an article like this, the pain of childbirth – which the majority of women feel – is minimized or explained as primarily a result of “fears”. Whoever has a pain-free or low-pain labor – more power to you! Be happy that you are so lucky. For most women, that is not the case. Throughout history, women feared labor because it was dangerous and very painful. We are not the first generation to experiment with “positive thoughts” and hypnosis. If these approaches would work so well, we’d know it – no one would need an epidural. However, they don’t. Some lucky women can get by with natural methods, some cannot, and some choose not to.

    Personally, I had two home births, one of them with excellent support by two midwives and a doula. I am young and healthy, watched positive birth movies and wasn’t scared (the first time). Both times, my labor pain was absolutely excruciating. Yes, I made it through – what else should I have done? But breathing to relieve the pain…? Come on. Try that with your next root canal treatment and tell me how well it worked for you. Yes, you’ll get through it if you have to – in fact, people did for centuries (just like they got through amputations and other horribly painful procedures without anesthesia). But it sure as hell doesn’t take the pain away. During my two home births, breathing, massage and mentally preparing myself for the next contraction helped me to not literally go crazy or become hysterical from the pain. That was it. It didn’t relieve the pain one bit. So, yes, I “made it”. Yay. GO, R. But what for….?? Who are we trying to impress? (Like one of the previous posters pointed out, modern epidurals are extremely safe, they do not appear to interfere with labor and due to the medication being administered into the epidural space and not your bloodstream, only very tiny amounts ever make it to the baby. There is usually no medical reason to forgo an epidural IF you want one – just like there is usually no medical reason to forgo anesthesia for root canal, or surgery or other painful procedures.)

    I absolutely agree with the argument that there is no other situation where extreme pain is deemed acceptable by health care providers, or where it is insinuated that, really, you should be willing to bear the pain (as babynurse and others on this thread did). Why is that? Are doctors and nurses “sorry” that dental patients ask for pain relief as soon as they can feel the drill, or that they “feel as though there should be no pain associated with dental treatments”? No. It’s only women who are, according to some, supposed to bite down and bear it.

    Just to be clear – I am not opposed to anybody laboring without pain relief. Why should I? (I myself did it twice.) Everybody should have the option to labor the way they want to, including good non-medical labor support. What I’m opposed to is suggesting that women SHOULD labor without pain relief.

    Yes, labor is a natural process, but nature doesn’t care for my pain level. All that matters to “nature” – ie, evolution – is if I successfully procreate. And I did – in pain, just like billions of women before me. However, as opposed to billions of women before me, I am lucky enough to live in a time and place where effective and extremely safe pain relief is available. It is absolutely ok to take advantage of that, or to desire a child birth that is (hopefully) truly pain free.

  30. avatar
    | #30

    Mmm, except many of those women would have torn ANYWAY – and that without pain relief. Have ANY idea what it is like for a woman to have a forceps delivery, torn apart from the inside, WITHOUT pain relief? Not only can there be 3rd / 4th degree tears for the rectum, the entire “foundation” area suffers traumatic injury. Which is uncontrolled, by the way… So in that sense, a C-section is much safer.

    Sure, the risk for epidurals in terms of tearing and so forth are statistically significant. But it is measured in terms of relative risk.
    I expect that many women would regard a 7% chance of instrumental intervention with an epidural, as opposed to a 5% chance of instrumental intervention without one, as an acceptable risk. (40% relative risk)
    The same goes for longer labour. Many hospitals refuse to perform epidurals during the first stage of labour – as performing them then is primarily what increases their risk.
    If faced with a mean difference of 5 MINUTES longer (second stage) labour (considering that you are in labour for approximately 12 hours or so), do you think women are really going to care?


    I would also like to know where people on this comment thread got the statistic that epidurals are likely to cause foetal distress in 10% of cases. I very much doubt that it is accurate. Perhaps the author would like to enlighten them.

    In terms of the increased risk, this is not necessarily CAUSED by the epidural, there are many other contributing factors. Correlation does not measure cause and effect! (Called the “lurking variable”)
    Especially with first births, women don’t know what “good” pain and “bad” pain is – they are just in incredible pain. Which is when you start shouting for the epidural.
    The studies look at foetal positions just prior to birth, not foetal positions just prior to the epidural. It is thus possible that women whose babies are in the wrong position, or experiencing foetal distress for some other reason, are more likely to demand an epidural.
    Genetic factors are a major contributing factor to tearing, even in births which seem like an “acceptable” risk for normal birth.
    An epidural cannot be administered while pushing. Choosing an epidural if you are going to need an instrumental delivery anyway – that seems like an absolute no-brainer to me, but perhaps not to those supporters of “good pain”.

    These studies don’t answer the question – do epidurals CAUSE all these problems, or are women who are more likely to suffer from them more likely to ask for epidurals?
    Even births for the same woman are not the same. So, you will never really be able to tell.

    Simple solution: If you don’t want an epidural, just say no :) Leave the women who need them (or want them) alone. Their birth choices are really none of anybody else’s business.

  31. avatar
    | #31



    1. Women may not regard a percentage which is “statistically” significant, as significant to their personal decision-making process.
    2. You are more likely to need an instrumental intervention just because you need it (5% prevalence in US) than you are likely to need one “because” of an epidural (7% at a 40% relative risk), even if you don’t account for (3) below.
    3. These studies don’t account for many potential lurking variables, including genetics and practitioner preferences.
    4. Women are monitored after they receive their epidurals, while they are not continiously monitored (at least with instruments like a foetal heart rate monitor) prior to having their epidural. Nor are they likely to receive an ultra-sound just before their epidural. This means that other factors (foetal positioning, other forms of foetal distress) which may cause excruciating pain and may increase the likelihood of such a mother demanding an epidural, are highly unlikely to be caught.

    And, let’s not forget the fact that very nearly ALL of these studies compare epidurals to other forms of narcotic pain relief, NOT to natural birth.

    Not telling women this, as good-intentioned as explaining the risks of epidurals may be… could very well be lying by omission.

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