The labor dispute: epidural or natural childbirth?

by Daphne R. Howland

Few first-time pregnant women are spared unsolicited advice from well-meaning friends about how to handle the pain of childbirth. To make things even more confusing, there seems to be two sororities: "Get the Epidural ASAP" versus "Natural Childbirth Is The Only Way to Have a Baby."

Sorting this out can be intimidating. It may take a bit of soul-searching to reconcile your own attitudes toward pain and your philosophy as to what type of birth experience you—not your partner, doctor or mother—want. As you make these decisions, though, be sure the doctor, nurse or midwife who will be seeing you through childbirth understands your instincts and choices.

A newer, better epidural

These days, pain relief in childbirth usually entails an epidural, whereby anesthesia is injected into a space in your spine between the vertebra of your lower back, numbing feeling from the waist down. Some variations, known as walking epidurals, combine pain relievers to allow more sensation and numb only the abdominal nerves. Because the walking epidural allows more movement and the feeling of contractions, women are able to feel when to push and help labor along. It also works fast; pain subsides within two minutes after the two-injection procedure. Traditional epidurals, also called spinal blocks, take 20 minutes to work, and they anesthetize the entire lower half of your body.

The epidural is revolutionary because it allows safe, effective pain relief that allows labor to progress almost naturally. You remain conscious, and little of the drug goes to the baby. In previous eras, the drugs often knocked a woman out or greatly impaired her and endangered the baby's breathing or other vital functions.

Other pain relief options

You can opt to receive opiate analgesics given intravenously that dull the pain but don't eliminate it. In fact, most women still feel pain and the contractions quite intensely. For some women, it's enough to get them through; for others, only an epidural provides the relief they seek.

The case against epidurals

Epidurals aren't without their own consequences and controversies. As with any drug, there are potential side effects and complications. In rare cases, complications occur due to incorrect administration of the drug. Also rare are side effects like serious headache or drop in blood pressure. As with any form of anesthesia, there is the risk of an allergic reaction to the medication.

Studies have shown that the use of epidurals may lead to longer labor, fever in the mother, or an increased use of forceps to assist with delivery. Researchers are also grappling with whether epidural use leads to increased rate of Cesarean section. One recent meta-study concluded there is no connection. But a critique of that analysis by Ellice Lieberman, MD, DrPH, a scientist at Brigham and Women's Hospital in Boston, says that it's too close to call.

"I think there is conflicting data out there. My feeling is we don't have the answer to the C-section question," Lieberman says.

Separating the issues

Every woman's labor experience is different—the progression of labor, the mother's way of handling pain, and how she values the experience. Bodies, minds and values differ even among close friends and, when it comes to labor, they add up to different versions of success.

Here's a guide to help you sort out the issue for yourself:

Reasons I might want an epidural:

  • I have a low threshold for pain.
  • From what I hear, labor pain is the worst pain of all.
  • It's safe for me and my baby.
  • It's worked for lots of people I know.
  • Why go through the pain?
  • I'm not in this for the experience of labor, I'm here to have a baby.

Reasons I don't want an epidural:

  • I handle pain well and I think I can go without it.
  • I believe breathing, relaxation and other mind/body exercises can help me handle the pain.
  • There are other pain relief drugs I'd rather try first.
  • I don't like the risks associated with epidurals.
  • Even though I don't know anything about labor pain, I'm not afraid of it.
  • I'm into the idea of experiencing the whole labor and birth experience intensely, without any drugs at all.

Most women have feelings on both sides of the issue, but you'll eventually find yourself leaning more one way than another.

Developing your birth plan

Many hospitals now ask you to fill out a birth plan so the labor nurses, midwives and doctors are aware of your preferences. If the nurses in labor and delivery know you want an epidural as soon as you ask for it, you'll probably get it then. But if you say you want to hold off as long as possible, they'll work hard to support you in the alternative exercises or medications you've chosen.

Think of your birth plan as mental exercise for yourself and information for the people who are trying to support you, rather than a contract you can't break. Depending on how things go, you may want (or need) to change your mind.

Pain, pain relief and society

If it sometimes seems that you're grappling with societal pressures that are bigger than you are, you're right. Donald Caton, MD, an OBGYN/anesthesiologist and the author of What a Blessing She Had Chloroform: The Medical and Social Response to the Pain of Childbirth From 1800 to the Present, explains that attitudes about childbirth and pain have reflected societal attitudes for centuries.

For example, in the late 18th and early 19th centuries, women in the English aristocracy wrote about their experiences with childbirth pain in diaries and letters. "This was long before anesthesia. It's clear to historians that the pain gave these women social status," Caton says. "The pain and the sacrifice had value, similar to wounds men received in battle."

Though many women today are opting for pain relief medication, the idea that the pain of childbirth has value hasn't completely disappeared. Women who value the pain are sometimes adamant that natural childbirth is the only way to have a baby.

Making your own decision

"Every treatment in medicine has side effects. I would advocate being informed about the epidural and weighing the risks and benefits," Dr. Lieberman says. "There isn't a right or wrong here. It just depends on who you are."

Remember, too, that your friends mean well. But just because they've "been there" doesn't mean they know what's best for you. Sisterhood can be found in motherhood no matter how your baby arrives.