Labor pains and epidurals
Labor and birth are hard work, and most women say that labor hurts a lot. But pain is subjective, and women respond to the experience of labor in very different ways. It is important to understand that pain does not need to mean suffering. There are many ways to help laboring women cope with the pain so that they do not suffer. Being free to move around, hot baths and showers, massage, having your support people present, and being in a comfortable place help a lot.
Epidurals provide effective pain relief for most laboring women, but effective pain relief does not necessarily make women satisfied with their birth experience.¹ Labor can evoke feelings of pleasure as well as pain, and medicine that numbs us to pain deprives us of the feelings of pleasure as well. Women's bodies make endorphins, which help women cope with labor, but any type of anesthetic will interfere with women's natural pain coping endorphins.
There are many different techniques and drugs used to for pain relief to women in labor. Some drugs have sedative effects, while others are numbing medications. Epidurals generally provide the most effective pain relief and are the most common, so I will focus on epidurals here.
Having an epidural transform an otherwise normal labor into a medical event. Once an epidural is administered, women will be confined to bed, given an IV, attached to monitors, and will likely be numb below the chest. Research about side effects of epidurals is far from complete, in spite of how commonly they are used. One difficulty in determining the side effects of epidurals is that the term epidural refers to a technique for inserting pain medication into the "epidural" space around the spinal cord, and not to a specific medication. Most women receiving epidural anesthetic get a mixture of several different drugs, which can include local anesthetics, opium derivatives and others. We know that some amount of the drugs given in epidurals will be passed on to the baby as well, though the effects of this are difficult to evaluate and not much research has been done. Some studies suggest babies born to mothers who had epidurals are less responsive at birth, and that epidurals may interfere with bonding between mothers and babies, but other studies have not shown this.² Research does indicate that epidurals significantly increase the risk of the following consequences in mothers: having a fever in labor, use of forceps or a vacuum extractor during the birth, more serious tears in perineum (tissue around vaginal opening) and episiotomy (cutting the perineum to speed birth of the head), and longer labors. Women who have epidural anesthetic are more likely to end up giving birth by c-section. For more information about epidurals and other drugs used for pain relief in labor, see the Maternity Wise web site.
Bibliography
1. Lowe, NK. The nature of labor pain. American Journal of Obstetricians and Gynecologists. 186:S16-24 (May) 2002.
2. Lieberman, Ellice and O'Donoghue, Carol. Unintended effects of epidural analgesia during labor: A systematic review. American Journal of Obstetricians and Gynecologists. 186:S31-S68 (May) 2002. |
