QuestionHi Catherine,
I am currently 28 weeks pregnant with my first child and have begun to seriously consider options for pain management during labour. My partner is strongly pro-epidural, but I'm a little more hesitant to jump on board. He believes that an epidural removes a great deal of stress from the labour environment and therefore results in a less stressed, more content baby. Is there any truth in this? What are other options for managing pain and decreasing stress during labour?
I would appreciate any information you have to offer.
Thank you,
Aim
AnswerAim,
To answer your first question, there is no truth to what your partner is saying. Babies whose mothers receive epidurals are at twice the risk of developing respiratory distress and other complications at birth, including low blood pressure and oxygen levels. There is also research to show that babies whose mothers receive medications are more drowsy and have more difficulty feeding, even up to 6 weeks after birth. They are also more prone to irritability, have lower pain and frustration thresholds and can be less consolable when upset.
All medications the mother receives during labour reach the baby to some extent. This includes medications given via epidural. They cross into the mother's bloodstream by diffusion and eventually cross the placenta to reach the baby via the umbilical cord. This happens fastest with narcotic agents and local anesthetics.
When you choose an epidural, there are also many other mandatory interventions that come with it which can hamper your labour. These include a continuous electronic fetal monitor, iv, restriction to bed, limited mobility, a urinary catheter, and blood pressure monitor. Also, since drugs can slow your labor, over 80% of mothers with an epidural will also have their labor augmented with pitocin, a synthetic hormone which causes unnaturally long, strong contractions that can further stress the baby.
Women who choose epidurals are also more likely to require other interventions such as episiotomy and forceps delivery or vacuum extraction. Since feeling is reduced, there is a greater risk of tearing and perineal damage.
Women who choose an epidural are also four times as likely to require a cesarean section.
To answer your second question, there are many management techniques which carry no side effects and can reduce stress in labour. The first is education. By preparing and knowing what to expect and how to recognize each stage of labor, you will reduce your anxiety and stress about giving birth. This means you will handle the experience much better because you will understand what is happening and what to do. I highly recommend taking childbirth education classes such as the Bradley Method, Hypnobabies or Hypnobirthing to educate yourself.
The next strategy is to have a labor support person with you at all times. This can be a partner or you can hire someone specially trained in this area called a doula. Use of a doula has been shown to reduce the need for medications and c-section rates by up to 50%. She will help you relax and provide physical and emotional support during labor. Most women who use doulas report greater satisfaction with their births and less pain overall, even with no medications. They also report swifter recoveries and have less complications during and after birth.
The next two most important factors are relaxation and positioning. Most pain in childbirth can be attributed to tension, restricted movement, and unnecessary interventions like continuous monitoring vs. intermittent monitoring. The most effective form of natural pain relief is water during labor. This can be from a shower or labouring in a tub. Water reduces gravity and helps you relax which allows your labour to progress easily. To learn more about natural labor pain management, see these articles: http://www.givingbirthnaturally.com/labor-pain-management.html
The next area is your choice of birth positions. Pushing flat on your back, called the lithotomy position, is actually the worst position to give birth. It narrows the pelvic outlet by as much as 30% and causes you to push against gravity. Research supports using upright positions, such as squatting, to reduce pain and prevent injury. To learn more about effective birth positions, visit http://www.givingbirthnaturally.com/birth-positions.html
Finally, you can be familiar with many natural techniques, but the key is knowing what will be helpful at each stage. For a detailed description of each stage of labor including which strategies are most effective at each point, read http://www.givingbirthnaturally.com/stages-of-labor.html
Good luck!
Catherine
