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Much like fashion and politics, childbirth trends are cyclical. In the au naturel 1970s, it was almost
unheard of to give birth with pain medication and without Lamaze practices. However, in the ’80s
and ’90s, the use of pain-relieving medications during childbirth was embraced, and pregnant ladies
by the thousands began requesting epidurals. With the new millennium came a resurgence of the
back-to-nature mentality. While most pregnant women still choose to receive pain management
drugs during their deliveries, reserving their preferences for all things natural for their next trip to
Whole Foods, women opting for natural childbirth is becoming more popular. Both options have their
pros and cons; the one you choose depends on your tolerance for pain and desire to have a drug-free childbirth experience.
To Drug
There are a few options you can choose from when deciding on pain medications: an epidural, spinal anesthesia and intravenous pain medications. There is almost always a trade-off when pain relief medications are used during labor; each woman must know and consider the potential benefits and risks and apply them to her own circumstances.
The most commonly administered method of pain relief during childbirth is the epidural, notes Isabel Blumberg, M.D., an obstetrician and gynecologist in New York City who is affiliated with Mount Sinai hospital. “Epidurals are the standard type of pain relief that is offered to pregnant women these days—at least in our practice. At Mount Sinai, we rarely use IV analgesia. Occasionally, IV medications can be given in early, early labor, but the majority of the time our patients receive epidurals,” she says. Dr. Blumberg also notes that a large number of her patients opt to receive medicated pain relief as opposed to choosing a drug-free childbirth experience: “We definitely see a majority of our patients getting an epidural—probably 95 percent or so. I think that these treatments are very popular because there has been a marked increase in awareness of the medicinal options to alleviate pain during labor. Additionally, a lot of the fears that women have regarding the epidural interfering with labor or breast-feeding, or [that it’s] associated with neurological side effects, back pain, etc., have shown to be unfounded.”
An epidural is administered to a patient by an anesthesiologist who, after numbing the area, places a needle into the epidural space of the spine. A catheter is then placed through the needle, and after the needle is removed, the catheter is hooked up to an ongoing infusion of pain medication. Once an epidural catheter is in place, additional medication can easily be administered as needed, providing prolonged and consistent pain relief. “This provides the long duration of pain relief that labor can require,” explains Dr. Blumberg. Epidural anesthesia can be brought up to a surgical level if a patient needs a cesarean during their labor for an unforeseen reason.
Many women find epidurals beneficial because they provide relief or reduction of labor pain without affecting the mother’s mental state, explains Penny Simkin, the author of The Birth Partner: Everything You Need to Know to Help a Woman Through Childbirth and co-author of Pregnancy, Childbirth and the Newborn: A Complete Guide for Expectant Parents. “An epidural allows the mother to rest during labor and save her strength for pushing during the delivery,” explains Dr. Joseph Sestito, an anesthesiologist in New Jersey. “This decreases her stress response and stress hormone release, and this most likely will help decrease the stress response of the baby during the birthing process,” he says. Simkin notes that some prolonged labors—especially those slowed by anxiety—speed up with an epidural. “Anxiety can cause excessive production of the mother’s stress hormones such as epinephrine and norepinephrine, which slow contractions. By allowing the mother to rest without pain, the epidural removes her anxiety and her labor progress may improve,” she explains.
As with any medication, there are some risks associated with epidurals, yet they are extremely minimal. “The risks of an epidural for labor in experienced hands probably occur less than 0.5 percent of the time,” says Dr. Sestito. Some patients report nausea, shivering, and mild to severe itching of the skin, while others may experience bleeding, infection and inadequate pain relief from a failed epidural. The most common complication is a spinal headache, which can happen if the woman moves inadvertently during the procedure and backs into the needle. The most serious risk of an epidural is accidentally entering the spinal space as opposed to the spine’s epidural space. When this happens, it causes a leak of spinal fluid that can lead to the patient having a severe headache the next day. “This complication occurs usually 1 percent of the time, and can be treated with IV fluids, pain medications and a blood patch, which uses the patient’s own blood to patch up the cerebrospinal fluid leak via another spinal if it is really severe,” explains Dr. Blumberg. In extremely rare cases, nerve injury and/or paralysis can occur as a result of a poorly administered epidural. To avoid these situations, it’s important for the doctor, patient and nurse team to work together to avoid sudden movements during the contractions and to try to do the procedure in between contractions, recommends Dr. Sestito. There is no data to indicate any long-term effects on the newborn, says Simkin. Dr. Sestito reminds women concerned about the risks of epidurals that in his opinion, the benefits far outweigh the risks. “These risks should not cause any alarm for women; my wife had an epidural for both of our children.”
IV pain medication—the most commonly used is Demerol—is given to the patient through an IV drip. Demerol alters how you recognize the pain you are experiencing by binding to the receptors found in your central nervous system. After it is administered, it takes effect inabout five minutes. “When it comes to the baby, the downside to IV medications is that since they go into the patient’s bloodstream, the babyalso gets some of the medication,” notes Dr. Blumberg. “This can lead to a baby being sluggish if he or she is born too soon after the administration of IV meds.” For the mother, Demerol can cause drowsiness, nausea, vomiting, respiratory depression and low blood pressure.
Spinal anesthesia is given in the case of a cesarean section delivery, when the use of pain-relieving drugs is not an option. A spinal requires less medicine and works faster than an epidural, but it is more likely to cause a headache or low blood pressure for the mother. It’s administered in a similar fashion to the epidural, using a spinal needle to enter the spinal space deliberately; pain medication is then administered through the spinal needle and the needle is removed. “This brings on a very rapid, dense block that can be used for surgery. However, since there is no catheter, it will wear off on its own in approximately two hours after administration,” says Dr. Blumberg. “Thus, it is not useful for labor.”
If you choose to receive pain-relieving medication during your delivery, remember that the line of demarcation between this route and a “natural” childbirth is a relatively thin one. “Although the definition of natural childbirth is different for everyone, I consider childbirth to be still natural while using an epidural,” says Dr. Sestito. Because the epidural masks the pain of the birthing process, most women are able to push better and stay focused during delivery.
Not to Drug
A natural birth is just as it sounds: the delivery of a baby without using drugs or surgery during birth. There are many environments in which one can have a natural childbirth; while some women choose to deliver with a midwife at home, others select to deliver in a hospital with a doctor or midwife who is aware and respectful of their desire to deliver without medical intervention.
Many who choose natural childbirth do so because they believe they’ll have a significantly more fulfilling childbirth experience without medication, and because they wish to be as in control of their bodies and the health of their babies as possible. While there are fewer risks involved when there is no use of medication, natural childbirth isn’t completely risk- or complication-free. “I don’t think that there are any major ‘risks’ associated with an unmedicated delivery aside from pain,” says Dr. Blumberg. “However, it can be more difficult to perform certain types of deliveries, such as those requiring the use of forceps, for example, without an epidural. Also, repairing any lacerations or episiotomies can be more difficult.” If electing to have a natural childbirth, one thing to keep in mind, Dr. Blumberg notes, is that if an emergency cesarean delivery is required, the mother might end up with general anesthesia—with which she’d be completely out—instead of a spinal, if there is no epidural already in place, or not enough time to put in a spinal.
If you wish to have a natural childbirth, it’s important to take certain steps to ensure it will be the experience you and your spouse desire. To do so, The Natural Family Site, an online provider of natural childbirth resources, recommends first finding a doctor or midwife who supports your decision to have a natural delivery. Next, you and your spouse should train for the birth so you know what to expect, how to manage pain and what to do at different stages of the birth. Such courses, like those in the Bradley method, are offered at many hospitals and birthing centers. Finally, the site recommends preparing a birth plan detailing your desires about a host of variables including drugs, fetal monitoring, episiotomies, IVs and birth positions. Research all of the options involving these and other delivery-related circumstances, weigh the risks and benefits, and choose the birth plan that works best for you.
—Chelsea Kaplan
Read all about Chelsea’s life with baby in her blog, “The Momtourage.”
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