Quote from lady_jezebel
I'm pregnant & assumed that epidural would be the way to go @ delivery. My doc feels certain that there are more effective ways of pain control -- deep breathing, self-hypnosis, etc... What are your opinions on this? Do epidurals have potentially major complications? From what you've observed or personally experienced, would you recommend an epidural?
I'm 33 yo and this is my first child.
I am a CRNA, and do frequent epidurals for laboring patients. The answers to your questions are it depends on you. Like most things in life, you will have your own perception of labor pain. Some women breeze through labor, and I have actually seen women who laughed and carried on conversations while pushing. Other women perceive it differently, and do not wish to try to tolerate it without epidural. L&D RN OH is correct, you need to do an honest assessment of your own ability to tolerate pain and discomfort.
That said, your doctor is wrong. While many women are well able to tolerate labor with breathing, self hypnosis, ete, these are not "more effective" than an epidural. With an epidural, you can undergo episiotomy without feeling a thing. I have done epidurals for patients undergoing abdominal surgery, including c-section, with no other anesthetic. That level of anesthesia cannot be attained with the methods your doctor suggests, so they cannot even be as effective as epidural.
Like most modern medical procedures, epidurals are pretty safe, but they do have attendant risks. Some of the complications are very minor, while others can be life threatening. However, the more severe complications are VERY rare. Bottom line is if I didn't think they were safe, I wouldn't offer them to patients. Placement of epidurals does not have to hurt. If sufficient local anesthetic is used prior to insertion of the epidural needle, then the worst you feel is the "bee sting" sensation of the local. After that, nearly all my patients tell me that all they felt was some fairly mild pressure as I inserted the epidural.
I do believe there are some advantages offered by epidural anesthesia. Generally, at the end of labor, women are exhausted, and spending time with the new baby is difficult. However, I usually put the epidural into my patients when they are dilated to about 4cm, and I advise them to take a nap if they can. They usually can. These moms are less tired after the delivery, and have more energy to devote to interacting with the baby.
There are a number of different medications that can be used in an epidural, each with its own advantages and disadvantages. I have found ropivicane/fentanyl to be a great combination. It takes between 3 to 10 minutes for the block to set up with a bolus dose of 8 cc 0.2% ropivicane with 100 mcg fentanyl. Then I run an infusion (not intermittent bolus doses) of 0.2% ropivicane with 2 mcg/ml fentanyl. Generally, ropivicane is more motor sparing. Therefore, the moms get a good pain block, and while their legs may feel heavy, they do not have the unnerving experience of being completely paralyzed below the level of the epidural. This also means they are better able to push when the time comes. (I'm telling you about the meds so you will have a little knowledge about what to ask the anesthetist.)
In the final analysis, the decision is not mine, it is not your physicians, it isn't the OB nurse's, its yours. Educate yourself, and make the decision for yourself. Don't let anyone (myself included) make your decision for you. The birth of a baby is a joyous event, that should be enjoyed under YOUR terms. If you don't want an epidural, then don't get one. By the same token, if you want one, don't be dissuaded by a physician who may have a prejudice against them. Its your day, it should go your way. If you have other questions, feel free to PM me, or even better, ask your OB to set you up an appointment to discuss your options with the anesthesia providers where you will have the baby.
Kevin McHugh, CRNA