Epidurals during Labor

From Childbirth International (where I am studying to be a doula):
"Epidural use during labor has become a popular method of pain relief. Many women find it difficult to make an informed decision regarding the use of epidurals since much of the information published is biased depending on the author's own perspective. For most women and their babies a drug-free birth is the safest choice. However, this may not be the right choice for all women. Women who have certain medical conditions may benefit from an epidural. If a woman is having a cesarean birth or she feels exhausted and cannot cope with labor pain she may benefit from an epidural. Making an informed choice means understanding the benefits and disadvantages of an option before deciding whether or not it is the right one."

The following are the likely standard interventions and potential consequences that are associated with the use of epidurals:

• Restricted mobility

• Intravenous drip with fluids

• Electronic fetal monitoring continuously

• Regular blood pressure monitoring

• Increased likelihood of bladder catheterization

• Synthetic oxytocic drugs (syntocinon or pitocin) more likely to be administered to stimulate or strengthen contractions
  
  

  Benefits of Epidurals

  The main benefit of an epidural is the relief of pain. In most cases, an epidural offers 100% pain relief during labor. However, this is not always the case. Occasionally, an epidural may only numb one side of the woman, or may leave her with pockets of pain.
• Other benefits:
  
  • Medical conditions like high blood (epidural helps lower it), certain heart conditions, it can help a women who is very tense to relax, intense back pain in labor, exhaustion.
  • Cesarean: if a woman is going to have a Cesarean, an epidural allows a woman to be fully conscious at the time her baby is born, and is able to breastfeed sooner than with a general anesthetic.

Risks of Epidurals to Mothers:

An epidural, like all interventions during labor, carries certain risks to the mother. These are due to the effects of the drugs administered, the placing of the epidural or the immobility of the woman. Short-term risks include:

• Hypotension (lowering of blood pressure)

• Nausea, vomiting and uncontrolled shivering

• Prolonged first and second stage of labor

• Maternal fever

• Pruritis (generalized skin itching)

• Uneven, incomplete or nonexistent pain relief

• Feelings of emotional detachment

In rare cases the following risks can occur:

• Respiratory (breathing) difficulties

• Convulsions

• Toxic drug reactions

• Slight to severe headache

• Septic meningitis

• Allergic shock

• Cardiac arrest

Risks of Epidurals to Babies:

•  Drowsiness at birth
• Maternal fever leading to neonatal workups in intensive care and administering antibiotics to baby as a precaution
• poor muscle strength and tone in the first hours
• Neonatal jaundice- possibly due to the administering of fluids and oxytocis drugs during labor
• Breastfeeding difficulties due to poor sucking reflex

The most significant risk of an epidural is the increased use of assisted delivery with forceps or a vacuum. An epidural relaxes muscle tone which is needed, especially in the pelvic floor muscles, to encourage the baby's head to rotate and move through the birth canal. When the pelvic floor muscles do not provide resistance, it is more difficult for the head to rotate which lengthens the second stage of labor and increases the risk of assisted delivery. In most cases, an assisted delivery will also require an episiotomy (a cut made to the perineum by the doctor).

Because of a woman's inability to be fully mobile and upright, the first stage of labor can also be lengthened.

Epidurals frequently slow down a woman's labor, so in order to speed it up again, oxytocic drugs are often administered. The oxytocic drugs are very effective at speeding up the labor, but they do carry risks to both the mother and the baby.

For more information:

http://www.sarahbuckley.com/epidurals-risks-and-concerns-for-mother-and-baby/

http://www.askdrsears.com/topics/pregnancy-childbirth/pregnancy-concerns/managing-pain-during-childbirth/epidurals

http://www.parents.com/pregnancy/giving-birth/stories/epidural-or-drug-free-birth/

I like this last paragraph from the Parent's Magazine article (3rd link):
Do What You're More Comfortable With
"The whole crazy debate comes down to this: we are all becoming moms, and if a mother-to-be will feel more triumphant and healthy and ready to tackle motherhood after a natural birth, then she should absolutely go forward with a natural birth. But if she feels more secure, comfortable, and ready to be a parent after a medicated hospital birth, she should proudly and guiltlessly do it."

 I think one of the most important things if you really break it down is that a woman does her research in advance. After researching her options, she and her partner make the most informed choice that they feel is best for them and their family. Don't put all your trust in your care provider- take responsibility and research for yourself. Then make a informed decision so you will have no regrets.