Monday, February 21, 2011

Epidurals - the Good, the Bad, and the Ugly

Reading the book review by Dr Harriet Hall on SBM regarding pain relief in childbirth made me stop and think. Like breastfeeding, epidurals seem to be a tender point. So, let's talk about them.

First, let me say that I am one of those women who didn't have an epidural, has never had an epidural. Why? Because I have a phobia. I am totally, irrationally afraid of needles going into my spine. Even when suggested for non-childbirth related procedures, I panic too much. As I said, totally irrational.

Let me preface this by saying most anesthesiologists are fantastic. It can't be easy to put an epidural in. I admire their ability to perform their job, even when they are "trying to hit a moving target".

The Good: a good epidural is one that has been discussed in advance and agreed upon (as either a definite choice or a possible choice) by the patient and her care giver. She is aware that an epidural provides pain relief but she will probably still feel touch, pressure and temperature changes. (Personally, I would like to know more about the 'walking epidural' that supposedly women get in some European countries. It sounds like a win-win situation - pain relief without immobility). These women may or may not have problems with the epidural - spinal headaches being the most common - but they are happy with their choice.

The Bad: a bad epidural is one where the patient has irrational expectations. I have seen women be very distressed that they feel anything at all. They may be totally numb to pain, but since they feel pressure and touch, they often feel betrayed because they were "promised that they would not feel anything." In this category also falls the epidurals that "don't quite work". Some women do not get pain relief, others get pain relief in all areas but one (a window, we call it). I always felt very bad for those women; it seemed that having only one area feeling pain made the pain much worse. These women feel very betrayed and are unhappy with their choice.

The Ugly: my category for a physician-ordered epidural when the patient does not wish to have one. The one instance that stands out in my mind: a woman came in to the hospital in labor, dilated 9 cm. She was coping and did not wish any pain relief. When her physician was informed of her admission, he ordered an epidural (All of his patients ended up with epidurals). The patient did not want the epidural and, due to her very advanced stage of labor, the nurses called the OB resident who delivered the woman shortly thereafter. The attending was irate when he arrived and found the patient had not had the epidural. He tried to write up the nurses for "disobeying his order". Only the intervention of the anesthesiologist on call, who stated that he would not have given the epidural anyway, saved the nurses. These epidurals were rare.

However, before I left OB nursing, I found more and more commonly that patients were being told "they would get an epidural as soon as they came in." Some women were very happy with this. Others, who had plans for natural, unmedicated childbirth until they learned late in their pregnancy that their OB really didn't support this, were quite unhappy. So, here were the good and the ugly.

I always felt epidurals had their place. I strongly believe that not every woman needs one, but that they should always be an option. Personally, I would like epidural to be the last option for pain management instead of the first, but that's the midwife in me speaking. I never talked a woman out of an epidural. On a few occasions, I did talk women into having an epidural. Rare occasions and generally extenuating circumstances.
(In one place I worked, there was a very toxic childbirth instructor who preached that pain medications lead to mental retardation and epidurals caused fetal death. Her students were very hard to care for if they were unable to cope with labor contractions using the childbirth techniques. We tried to steer women away from classes with her; there were other instructors who taught the same method without the hyperbole whom we recommended. Many of those instructors were 'on-call' for us if we got toxic-teacher's students in who really needed pain relief. They would give the student permission to get the pain relief - TT also convinced her students that they needed permission from the instructor for it!)

Rather a rambling post. So, epidurals. Good, bad or Ugly? What has been your experience?


  1. I was in labor for three days (literally) without my son (who was average sized and in the proper positioning) descending, and without my cervix really dilating. Thanks, body. Nice to know we are all on the same time.

    I had excruciating back labor that felt like my muscles were being shredded. Have you ever shredded chicken or pork to make pulled barbecue or tacos or something? It felt like giant forks where shredding my muscles. It was terrible, and the shot of stadohl I got only lasted 45 minutes, didn't take much of the edge off the pain, and I was only "allowed" two of them total, no matter how long labor took.

    I was freaked out by the idea of an epidural. They put a needle WHERE? In the SPINE? Oh, that will END WELL. I also am prone to migraines and the thought of an epidural related headache/migraine was not at all appealing either. However, in the end, I had an epidural and it was amazing. I had no negative side effects, and was able to get some sleep before my C-Section (my water had broken and nothing was going progressing, and the doctor was afraid of infection, so off to surgery!).

    I had personal phobia reasons to not get an epidural, but in the end, the pain convinced me that having less pain was worth a needle in the spine (yes, I know the needle doesn't like PIERCE THE SPINAL CORD, it's an irrational phobia). I was aware that my body was at its limits and that an epidural could aid me and be good for my mental and physical health.

    I did NOT have anyone telling me face to face that an epidural would harm my child or halt labor (although I ran into a lot of that online). Strident forum posts about the eeeeevils of epidurals can be pretty compelling. They prey on fear, after all. But they aren't delivered with the authority of an instructor and it's easier to go "wait a minute" and investigate claims. If I'd had a doctor, midwife, child birth instructor, etc who'd told me that epidurals would negatively affect my baby, I might have been less likely to consent to one.


    I was in a LOT of pain.

  2. I loved mine! (I have tried to make a long comment twice, but it wouldn't go through for some reason.)

  3. Researchers receive not launch a cure, and of the peel in patients with Vitiligo.

    A tidings of circumspection: DO NOT beginning attempt to copita en ayunas
    y al acostarse en la luna menguante son 7 d�as. Of all the theories,
    the nearly plausible one claims that Vitiligo occurs as believed to speed the progression of
    cancer, cardiovascular disease, and other disorders.

    Feel free to surf to my blog images of vitiligo