Episode 39: Epidurals - Benefits & Risks

Last week we talked about medical interventions, birthworker/medical care provider biases, and how important I believe it is to talk about birth from a balanced perspective. Informed decision making means looking at both the benefits & the risks of any given intervention (balancing these - of course - with your own values around medicine, risk, & birth). 

In this weeks video we implement this practice of addressing both the benefits & risks of a decision while discussing epidurals. While there are a list of risks associated with the epidural, there are two very big benefits! It's important that you go into birth with your eyes wide open, fully aware of the risks and benefits associated with your decisions. 

Embark on your birth journey with courage! 

Full Transcript:

[00:00:00] Welcome to the next free weekly Brave Journey Birth Preparation Video, where I pick a topic related to birth or postpartum and I talk about it. Today we're talking about epidurals. Specifically, we're going to implement what it is to talk about epidurals and interventions from a balanced perspective, where we talk about the benefits and we talk about the risks.

I'm Cara Lee, I'm a birth doula and a childbirth educator and let's get started.

First, let's start with what is an epidural. You've probably heard of it. You probably know that it has something to do with pain relief. An epidural is when a medication is placed directly into your spine. So first, an anesthesiologist will come in and [00:01:00] apply a local anesthetic to numb your skin. And then they'll apply a needle into your spine at a very specific point. From which point they leave a tube behind where medicine can continually be placed into your spine. Because the epidural fades over time, the effects of the epidural fade over time. So you can add medicine as necessary. So that tube stays in your spine. You can't feel it in there and they tape over it. It stays taped to your back. And from that point, there's a medicine attached to the tube where you can add medicine directly to your spine. The effect is you become numb from about the chest or the lower chest down. So let's talk through some of the benefits and some of the risks of having an epidural placed.

The benefit is that the epidural is the most effective pharmacological pain relief option available for somebody in labor. This is just a fact. So in the Brave Journey Birth Preparation Program,, we go through a full list of all the most common medical interventions. And we compare [00:02:00] various different pain relief practices.

Some are pharmacological medications, and some are pain relief practices that are don't involve medications. And we kind of rate how different birthing people rate pain relief efficacy, and the epidural is by far the most effective pain relief option that we have available in labor. So that's a benefit.

Another benefit of the epidurals that's often can be used, not just for pain relief, but as an option for rest. So I often try to prepare my clients for the fact that sometimes the most difficult part of labor is not the pain. It is. Intensity and how much stamina you need. So if, if your labor, it turns into a very long labor, that includes a night, two or three of missed sleep. Sometimes what you're facing is not pain being overwhelming, but exhaustion and fatigue. So sometimes an epidural can be a really compassionate and wise choice as an option to get some sleep, to rest and to regenerate and build [00:03:00] your energy up so that you're ready when it's time to push. So those are some benefits for epidural.

And I started with benefits on purpose because I often see people on the internet, vilifying epidural as a form of pharmacological pain relief. And I want to come back to my own philosophy and way of looking at medical interventions, which is that sometimes when mindfully engaged, interventions are the wisest choice, you have to decide what's right for you.

so in order to also have a balanced perspective, let's move on to talking about some of the risks that come with an epidural. So when you select epidural , it inherently medicalizes your birth. Because with the epidural calls, what some people like to call the "cascade of interventions", and it can feel like that if you're not prepared for it, but just know an epidural comes with not being able to leave your hospital bed. So then you become somebody who everybody is taking care of. So that dynamic completely changes. When you're laboring without an epidural, you're [00:04:00] standing up, you're moving around the room, you're rolling on a birth ball. You're maybe pacing the halls pre COVID, um, hospitals aren't necessarily letting you pace the hall right now.

Um, but you know, you're actively laboring. Once you have an epidural, you become a patient because you're lying there. You have a catheter where they place a tube up into your urethra to collect your urine, which then goes to a bag that's adhered to bed, the hospital bed. It includes for sure. Um, IV fluids. So an epidural, one of the risks of an epidural is it causes low blood pressure.

So you add IV fluids to counteract that effect. So you've got a catheter, you've got IV fluids. You also need continuous monitoring at this point. So there's no option to ever take these monitors off you are, you're monitoring the baby's heart rate, you're monitoring your contractions.

And I'm just trying to give this to you in a balanced way. We just make educated and informed decisions.

So another risk of the epidural is that it tends to slow your contractions or perhaps even cause them to go away. So, often when you get the [00:05:00] epidural, your also going to start Pitocin. So Pitocin is a medication that causes longer, stronger and closer together contractions. In a different time, we will talking about the Pitocin intervention in terms of the benefits and risks of Pitocin as a medication.

So this is what I mean by medicalizing your birth. When you choose to have the epidural placed, you also are choosing all of these other interventions that come with some of their own benefits and risks as well. Like I said, some childbirth educators, or birth doulas will call it the cascade of interventions. And that is because it's often something that people are not prepared for or adequately informed about. So it's just a triggering a series of interventions with this one choice. So it's something to be aware of. So that you're walking in eyes wide open. Mindful decision educated.

So while I mentioned that it is the most effective pharmacological pain relief available for labor, unfortunately one in eight people experience it as not adequate pain relief.

So when it works, it is the most effective, however, one in eight people will say [00:06:00] that it's not a complete pain relief, or it will be partial pain relief. And it's like one side of the body versus the other. So there are things we can do if you're experiencing that to turn you so the medicine moves.

But that can be really, really frustrating because it's very hard. One of the best ways to manage pain and is through movement and positioning. And when you've lost that option, because half of your body is numb, uh, it can make the painful part feel that much worse. So again, eyes wide open. These aren't scared tactics. This is going into this, knowing your options and making informed decisions.

Another risk that comes with the epidural is that will slow down your labor. And it increases the lenth of time it takes to push. Because it's difficult to push when you don't have good feeling in the muscles that you need to use. So when it comes to the pushing stage, you have to be active. You have to be working hard.

And sometimes if you become too numb, you have to wait for the medication to fade a little bit so that you can find the muscles necessary to push. So it does statistically, evidence-based, the epidural does increase the length of your labor.

Uh, [00:07:00] lastly, uh, a few other risks is that one in a hundred people will experience that a long-term spinal headache that takes a while to heal. It's very severe. I'm not trying to minimize it because one in 100 is actually kind of high. But it's not that everybody who has an epidural had experiences a spinal headache over the next few weeks to months.

And then another thing is it causes itching and nausea. So you'll often see if someone has an epidural they're often itchy and they sometimes don't even notice they're doing it, but that's the medicine. And it also can cause nausea, because again, the medicine in the body it's like different people respond to medicine in different ways.

So those are some of the other side effects that can be associated, and risks that come with the epidural.

All of these risks are balanced with the fact that the epidural is the most effective, when it works, the epidural is the most effective pain relief available, and lots of people choose it, but you want to choose it with your eyes wide open.

You don't want to be walking in, not realizing all the other things that you're selecting as [00:08:00] well. It's a very different way to labor and have your baby then to be active and up and moving around. But it's your choice. You get to choose. You get to decide what's best for you and what's best for your baby. And if you do choose to use the epidural,, when we talk about it in the Brave Journey Birth Preparation Program, we also go through tips for how to strategically use the epidural.

Okay. So that's just it. We just talked about the epidural, the benefits and risks, and all here to give you your information and make sure you're making an informed decision.

I will see you in the next video. See you next week.