Epidural vs. nature births

CNABESS · Apr 24, 2011

I had a mother that gave birth to 8 children, 7 completely natural, the 8th there were difficulties and she was given something, not sure what, but things went well and everybody was okay. This was 4-5 -55 years ago, so she was WAAAYYY ahead of her time. I loved being in control of my labor, and the epidural helped me with that. I think natural anything is better, but I do not like it when women are made to feel like they have failed if they do not go the all natural route. After all, most of us would not have dentistry, or stitches without some sort of pain relief. Women need to realize that the decision is their own, and not a measure of their abilities as a woman or a mother. All of you that work in L& D, I think you are Fantastic!!!! It is a tough job and so glad for awesome nurses to help me through it when I was giving birth.

tainted1972, ASN, RN · Apr 24, 2011

I have 3 children, I was induced all three times. The first two I had epidurals very early and had to lay in bed the entire time which I hated. (I was in labor for 21 hours the first time)

with daughter number 3, I wanted to wait to have the epidural for as long as possible, but I was encouraged to have it early, I was told that if I did not get it now that the anesthesiologist may not be available when I wanted it. That may have been true, however, I felt like I was pushed into getting the epidural before I really wanted to.

It was the only time medically that someone has talked me into doing something that I did not want to do. I will NEVER allow that to happen again.

I learned from that experience, as a nurse I do my best to always advocate for my patients and by all means never attempt to talk them into something they do not want to do.

SkaterGurl · Apr 24, 2011

I just completed a maternity rotation and during my rotation (my shifts) every single woman had an epidural. Half had completed some type of childbirth class. I had the opportunity to ask one woman how her mother had given birth to her and was told "epidural" was the only option given to her mother. I think we are becoming a culture that doesn't know how to give birth without 100% intervention and we expect no pain. I'll not go into my own birthing experience except to say both were natural (both in the hospital) and yes, it did hurt but only for a while .

I also believe women aren't offered a choice, and aren't empowered to act on those choices out of fear.

Elvish, BSN, DNP, RN, NP · Apr 24, 2011

L&D at my place doesn't really push anything one way or the other. Lots of moms get IV pain meds or go natural if they want. I will say there are some nurses who enjoy the natural-birth process more than others and will volunteer to take the patients who want to go natural, but overall, most nurses will support the patients' choice regardless and not try to talk them into or out of anything.

I had an epidural with my first - nice because it relaxed me and I went from 2 to complete in about 6 hours, whereas I'd spent 8 hours after SROMing getting from 1 to 2 with nothing at all with contractions that I thought were going to kill me. The downside was that 1) I didn't really get to be an active participant in labor while dilating - my body did it for me and I didn't really have to put much effort into it. And 2) my legs were so dead I couldn't really maneuver myself into a decent position for pushing, so had to have a ton of help with that and ended up being more or less flat on my back between pushes. Bad idea for a posterior baby; don't want to do it again. Would the experience have been better, worse, or the same with different method of pain relief, there is of course no way to know.

All that to say, I'm not one to criticize epidurals. They do have their place. But I do want to do things differently this time around (almost 35 weeks along with #2 - yeah!). I'd like to see what my body is capable of.

SharonH, RN · Apr 24, 2011

My "professional" opinion about epidurals vs. natural births is that I will support whatever decision you have made concerning pain management in labor.
My "personal" opinion (which does not enter into my work hours) is that it is a shame so many young women have been so disempowered and have no belief in their own strength and ability to go through childbirth. I can't imagine giving birth as a spectator to my own labor and delivery.

I had both my children naturally. In both instances, I was in so much pain and I was so focused on getting through the contractions that I feel that I "missed' their births. All I could do was concentrate on pushing so I could get the kid out so I could take a deep breath without feeling like I was dying. Just offering a personal point of view from the other side.

As for the nurses, at not time was I encouraged to take either route. After my son was born, one of the nurses commented that I was doing so well and that I was actually less work for her as I ambulated to the bathroom with only the assist of my husband and I required less monitoring than if I'd had an epidural.

destova · Apr 26, 2011

I find it interesting that not once in this conversation has the complications issue came up... epidurals force women to stay on their back in a position that is helpful for medical procedures, but not at all helpful in the world of pushing a child out- the pelvic bones are aided by gravity and baby's position if a mom is up a bit (squatting, crouching, on hands and knees, etc). Also, epidurals have been shown to slow down labor, which can cause doctors to use the beautiful "failure to progress" (in their timeline anyway) reasoning for a c-section.

I'm not saying in any way that epidurals are terrible or that they don't have a place in L&D, I understand that each individual woman needs her own methods- but I am saying that there are more issues here than just "what mom wants"- I suspect that if mom were fully educated on the possible risks and issues, she might choose differently. Also, if mom wasn't stuck in a bed on external monitors the entire labor, she would progress faster and with better means to work through the contractions.

I'm speaking here from education as well as personal experience. I've had five children. The first was with epidural for all of 5 minutes before it came out and began to medicate the bed (I told the nurse "I feel a puddle on my back", she says "oh, its just amniotic fluid" when my water had not yet broke! she finally came over to check to get me quiet and stood there stunned at the fact that a silly pregnant teenager knew something was wrong). The next was without epidural but in the same hospital- again strapped to a bed with monitors and discouraged from moving around at all. The next three were without epidurals (I'd already learned that I could do it without) and in a different hospital where they encouraged mom to be up and moving, to follow her body and instincts. Very very different labors/deliveries!

When looking at these types of issues we need to not only think of what a woman wants in her own birth experience, but also at what value the intervention provides versus the risks and complications it can cause. Women have every right to make their own choices for their own bodies, but should be well informed before making that choice.

destova · Apr 26, 2011

realized I didn't answer the OP. We have two hospitals here, one very much assumes all laboring women will want/get an epidural. It is acted on without much thought and their wording shows the assumption, "here's your call light, my name is Sue, you can expect to see Dr within the hour, don't get up without help, and you can let me know when the pain is getting worse so we can get you fixed up with your epidural" is pretty much the speech given on admission.

The other hospital is a bit more natural in that they use massage, counter-pressure, ambulation, breathing techniques, etc. and treat epidural more as a "maybe" than an assumed fact with each mother. This is not so much hospital policy as it is that the head nurse and the department head were good friends who worked well together and taught the nurses under them the skills they trusted, those skills are now being passed on to new floor nurses.

Its more the nursing culture than the hospital policy that is different between the two hospitals I guess.

I'd be very interested to see a comparison between the two hospitals in terms of c-section incidence, % of mothers being induced via pit, and use of epidurals. I'm not sure it would be statistically huge in comparison but it would be interesting...

klone, MSN, RN · Apr 26, 2011

Destova, perhaps I'm wrong, but I'm assuming that this discussion *is* in the context of weighing risks vs. benefits, and providing informed consent to laboring women.

The fact is, most women I know who go into the hospital saying "I don't want an epidural" and then end up getting one anyway - they KNOW what the risks are (which is why they wanted to try to get through labor without one), but by the time they ask for an epidural, they simply don't care. They're in too much pain and they want it gone. Nevertheless, we still have to go through the consent and explain the risks/benefits of the epidural. I find that our CRNAs and anesth. residents are very good about that, as are our midwives.

caregiver1977 · Apr 28, 2011

I delivered all five of my children at my local hospital. When you are admitted they are pushing an epidural the whole time you are in labor (until it doesn't make sense to get it anymore). If you are a mother, like me, who does not want pain meds and certainly no epidural then the staff looks at you like you are crazy. Women who aren't begging and screaming for drugs and accepting all that is offered are viewed as something strange. If a laboring woman changes her mind and accepts drugs, the staff actually looks relieved. I once had a nurse that raised her voice at me twice because I didn't want an epidural. She even brought in the anethesiologist (sp) to try to convince me. I told him I didn't want it and he was looking at this nurse like "okay, so why am I here?" From what I know of, my local hospital only manages pain with drugs; no natural forms of pain relief are attempted.

I never had an epidural and don't regret I didn't get it.

destova · Apr 28, 2011

klone,

I wasn't being judgmental of the thread or posts, just found it interesting that no one else had brought up the complication risks and drawbacks yet- I had expected to find that in one of the comments.

My question is how many of those mothers who end up wanting one because "they're in too much pain and they want it gone" were given the opportunity to work through the pain in a position other than laying down on the bed hooked up to monitors? I am not in any way saying that L&D nurses don't do a good job at helping women through labor and delivery- I'm just saying that the current attitude of our culture seems to be that a woman checks into hospital, lays on bed, gets hooked up, and stays in that one position throughout. So even women who have the benefit of nurses who try to show them other ways, those women have already fully taken in the image of woman laboring in bed. Peek at any message board for expecting mamas and the perception and attitude there are unreal! It seems as though women as a culture have forgotten that we were anatomically built to give birth, and too many medical professionals help to enforce that image.

I've seen myself how the attitude in general at a hospital can change the way L&D nurses work with their patients- at our more natural friendly hospital we've had L&D nurses come in from the other hospital and be in a sort of culture shock their first few months on the job... "Shouldn't mom be monitored?!!?" "You're letting her walk around at 8cm dilated? Is that safe?!?" Even as an aide (at that time LPNs on the floor were only "aide" or "tech"), I could tell the perception of birth was vastly different between the two hospitals. And those nurses were always more shocked when a patient would choose no epidural- they seemed equally shocked that the nurses on the floor felt the women were better off without them because of the risks and decreased mobility/ability to change positions and ambulate as needed.

sorry so long!

MrsEd · Apr 29, 2011

We do not stop the epidural pump when the mother starts pushing. We keep it going so she has pain relief through the entire process and if a repair is necessary.

Ditto

hecallsmeDuchess · May 2, 2011

Thank you all for the different opinions. I've always thought to myself that when I'd be pregnant I'd ask for the epidural as soon as I get admitted. Wimpy me! My rationale was that I didn't want to embarrass myself screaming bloody murder through labor pain, (I couldn't live with myself if I screamed uncontrollably). I just haven't thought about or researched risks/benefits of getting an epidural. I think it's beneficial for a woman to know that waaay before labor starts.

But those of you that had kids without an epidural, was the pain that bearable? If it was, why do people make it seem like labor is this journey to hell that only a few brave ones come through unscathed? And those that got an epidural, what are the side effects you experienced?