What the F*#% is an epidural?

The major debate in childbirth right now is natural childbirth vs medically oriented childbirth. Which is better for mom? Baby? The hospital (now there's the question no one is asking. But we should since what is in the best interest of the doctors/hospitals can influence the medical advice we are given.)?

I am not here to tell anyone what they should do during their birth experience, and I think that too often feminism forgets that at its roots the movement is about giving women choices and not vilainizing them for any particular choice. Epidurals are not inherently evil, they provide a valuable service to women who through whatever circumstances cannot (or feel they cannot) endure labor without pain management.

Here's an example of how epidurals can be beneficial when used appropriately. My Sister in law (written as SIL from here out) had planned to have a home birth attended by a midwife. SIL went into labor in the middle of the night and waited it out, progressing slowly. Her water had broken and she was having strong contractions, but the labor dragged on and on and after 24 hours of labor her midwife came to this conclusion: she did not doubt that SIL would eventually birth the baby. What was in question was whether or not she could actually push the baby out after 24 hours of labor without sleep. SIL couldn't sleep because of the pain and discomfort and the midwife was concerned that she would be too exhausted to push when the time came. So the decided that they should all go to the hospital and get SIL an epidural so that she could get some rest and would be strong enough to continue with her vaginal delivery. And that's exactly how it went. SIL rested and when she was strong enough, the epidural was taken out and she gave birth to a beautiful baby boy. Now this is not a typical birth and most women will not have this problem, but that is exactly what epidurals and medical interventions are for...they are for those unexpected complications. Unfortunately today they are seen more as necessary and routine which is where part of our problem lies.

Ok, going back to choices. I am all about women's choices and that the choices made in childbirth should be made by the mother, however, I believe that uninformed choices can be just as bad as no choice at all so I decided to put the information out there so that women can make informed and empowered decisions about their birthing experience. The following are the scientific facts behind epidurals: what they are exactly, the drugs they are composed of, side effects, etc. Some of this may seem scary (and my intention is not to shock you out of getting an epidural) but I think that is because it is inferred that medical interventions are harmless or else why would our doctors give them to us? That is a question to be answered at another time I am afraid. Anyway, on with the show...

If you look up epidural in an online encyclopedia (in this case wikipedia), you will find the following:
note: I have added links to things that people might want to explore in more depth.

The term epidural is often short for epidural anesthesia, a form of regional anesthesia involving injection of drugs through a catheter placed into the epidural space. The injection can cause both a loss of sensation (anaesthesia) and a loss of pain (analgesia), by blocking the transmission of pain signals through nerves in or near the spinal cord.

Ok, but WHAT is it...what's in it? Read on...

A patient getting a modern epidural for pain relief generally receives a combination of local anesthetics and opioids. Common local anesthetics include lidocaine, bupivicaine, ropivicaine, and chloroprocaine. Common opioids are morphine, fentanyl (80 times stronger than morphine), sufentanil (5-10 times more potent than fentanyl), and pethidine(aka: Demerol). These are then injected in relatively small doses. Occasionally other agents may be used, such as clonidine or ketamine.

Ok, so now I finally had the answer to my question (what the f*#% is an epidural). An epidural is made up of some serious narcotics....I must admit I was a little surprised. Now here is my next question: Our entire pregnancies all we hear about is how drugs are bad and anything we take gets into the baby's blood stream, etc., etc...so why is it suddenly ok to take morphine or demerol right before our baby is born? And don't fool yourself, epidural drugs are not special...the baby gets those too.

So now we know what is in our epidurals, now lets look into some of the sides effects. As we all know from watching pharmacuetical commercials, ALL drugs have some side effects, here are some of the general effects of an epidural:

• Loss of sensation (including touch) - well this was kind of the point!
• Loss of muscle power
• Loss of function of the sympathetic nervous system, which controls blood pressure

So, lets see what we've got: Loss of muscle power (so most women are confined to bed to prevent falls), drop in blood pressure (this can have further implications), loss of sensation - lets look at that last one a little more closely.

Epidurals work by blocking the pain signals that your body is sending from getting to your brain. But what works one way works both ways and if your brain can't get signals then it is likely that it can't properly send them either (well, it's sending them, but no one is answering the phone). This means that often women can't feel how hard they are pushing and can end up causing more tearing.

Ok, let’s have some more: Epidurals are often associated with maternal fever, loss of bladder control, nausea, and vomiting, and respiratory depression. So now you are confined to bed with a catheter in your back and one in your bladder and you're puking....lovely! Hospitals also usually require women with epidurals to be under continuous fetal monitoring, something that not all women want.

One major thing to consider, Epidural analgesia is associated with longer labor. The epidural can slow down labor, sometimes completely arresting it requiring further intervention in the form of labor induction drugs (namely pitocin).

There is lots of debate over whether or not epidurals contribute to higher rates of c-section, and I am certainly not going to argue that I know the answer, but if you look at some of the side effects caused by the drugs given during an epidural, then you realize that since you are passing these to the baby, the baby can also exhibit these symptoms (depressed respiration, drop in blood pressure, fever). Given that you are being continually monitored, doctors can see these changes and may be concerned that your baby is in distress. When doctors are concerned with fetal distress, c-sections often ensue. Now, I am not saying that if you get an epidural, you are going to have a c-section. What I am trying to do is use the facts and paste them together logically so that women can understand how these things turn from simple pain management into invasive surgery.

Again, I am not saying that women shouldn't use epidurals. If that is what you want...go for it. But, you should have all the information before you make your decision. Also, if you do want to have an epidural, do it for you. Don't do it because your doctor or society is making you feel like you can't bear the pain. Yes childbirth hurts, a lot, but it is supposed to hurt. We have been giving birth since the rise of our species. Therefore, you CAN do it, but you don't have to and that is the point of feminism. Empowering women to make their own choices.

So please ladies, lets start supporting each other instead of judging each other. Women need the support of other women. So if a friend says they want an epidural don't judge them, just make sure they have all the info and let them do what they think is best. And conversely for those of you who are all about medical intervention, that is your right and good for you, but don't make me feel like I am endangering my child by using a midwife instead of a OBGYN, going to a birthing center instead of a maternity ward, or saying I want to deliver intervention free. And for God's sake, calling someone modern, feminist, or natural is not an insult so stop trying to use it as one.