Monday, December 05, 2005


Epidurals are considered the “gold standard” in pain relief. They have been shown to provide better pain relief and more continual support than other forms of anesthetic or pain medication. The use of epidurals has been widely studied in terms of effectiveness, especially in comparison to the other available medications. However, there are no randomized studies comparing the effectiveness of epidurals in birth to births where no pain medications are used. Additionally, most studies regarding epidural use have not looked at overall maternal satisfaction of the birth.
Epidurals are a type of anesthetic administered into the lower region of the spine. The anesthetic may be a combination of anesthetic drugs such as xylocaine and bupivicaine, and opioids such as fentanyl. Once the epidural has been administered into the spinal region, the anesthesiologist must remain available in case the epidural needs to be turned off, turned down, or dosage increased.
Epidurals are useful when a woman can no longer labor without pain relief and when a woman is being referred for a cesarean birth. However, this gold standard of American birth culture does not come free of side effects and risks. First of all, the use of any intervention, including epidurals increases the use and need of other interventions. Studies show that the use of epidurals increases the likelihood of a cesarean birth from 10-50%, depending upon the stage of labor. Women are 50% increase in cesarean rate if the epidural is administered at 2cm, a 33% increase at 3cm, and 26% increase at 4cm (Dozar and Baruth, 1999). Other interventions include an increase in forceps and vacuum extractor deliveries. Often these procedures become necessary because the woman has trouble pushing. Epidurals inhibit leg and muscle sensation and control and often prevent a woman from birthing in upright or more effective positions. Additionally, if women receive an epidural in the earlier phases of labor, less than 5cm, the likelihood of the uterus relaxing increase. This may cause the baby to remain or move into a less than optimal position, which in turn may increase the difficulty of pushing.
Potential risk factors or complications caused by epidural use include, but are not limited to maternal hypertension (which can lead to fetal bradycardia and distress), urinary retention, mild to severe headaches lasting up to a few days, backache, septic meningitis, maternal and fetal toxicity (epidural anesthesia crosses the placenta and into the fetal blood stream), discoordinate uterine contractions, fecal and urinary incontinence, slowed uterine contractions and thus the need for oxytocin, allergic reactions, seizures, and ineffective pushing. Additionally, women may experience uneven numbing and dissatisfaction in the birth process if they were hoping for a natural birth. The WHO explains that despite the fact that women who receive an epidural may be considered low-risk, they are no longer having a “normal birth” because an epidural changes a natural experience into a medically managed procedure. Medical management is not part of the normal, physiological process of birth.
Both women considering and wanting an epidural should be supported in their birthing process and the choices they are facing. Women who are able to surrender to the birth experience and who are able taught to cope with their fear may experience less tension in their body and therefore less pain. Having a supportive, loving and nurturing birthing staff and partner can help women release into the birth process. Additionally, studies have shown the women undergoing good CBE classes and women who choose to have a doula present at birth are more likely to be satisfied with their experience, and often do it without becoming a part of the epidural epidemic.

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