Epidurals – Pros and Cons

Lots of people think nothing of getting an epidural. It is overwhelming the norm, but I want to give you a look from the other side.  For this blog, I wanted to talk about some of the downsides of epidurals. We did an interview months ago with Kayla Holtz and talked about how in some cases an epidural can be a game changer for birth to progress.  This is not the case for everyone though.  Every birth is a personal journey.    

I did not have an epidural for either of my two deliveries.  I did not do this because I like being in pain or just to be able to say that I did it without an epidural, but for a few different reasons. I will go over those later.  I believe that these significant reasons are glossed over and I want people to make their decision for their birth plan based on all the facts and different scenarios that might happen so that they can make the most informed decision.  I like to promote individualized birth plans that are specific and geared towards you, your family, and your   situation to make birth super adaptable as it is almost always unpredictable. 

My Main Reasons For Not Getting An Epidural

The first reason is because of my biomechanical background and working with the prehab and rehab and postpartum journeys of patients. Because of such knowledge, I did not want to have a C-section. Sometimes, having an epidural can have a domino effect leading to a woman being more likely giving birth through C-section. This is not intuitive so you have to peel back the layers to see why having an epidural will more likely let you have a C-section.

One of the things that happen when you have an epidural is that labor can slow down or stall. When that happens, to let your labor progress, they will most likely give you Pitocin, which is a shot that helps speed up labor. That is great in itself, but it can be hard on the baby. You are not feeling the pain when you have an epidural, but babies are under a lot of stress because the contractions become fast and hard. Oftentimes, that can then cause heart irregularities in the baby and you are forced to push before you are physiologically ready. When that happens, it is not good for you or the baby.If you do not progress quickly enough, the baby will be under stress and you will either end up pushing too soon and exhausting yourself, an episiotomy, vacuum, or end up having a C-section.

C-section is a major abdominal surgery that I wanted to avoid. I work with patients all the time rehabilitating that scar and reconnecting the brain with the core. It also leaves you open to low back issues and SI issues because of the instability in the core. The other thing is that if your core does not feel centered and strong, your brain starts to lock up things around it leading to shoulder issues, hip issues, neck issues, and more.  This all comes from poor stability. That is why we always start with core in the office.  It is all connected. Abdominal surgeries are no joke and the healing after a C-section needs to be respected and not rushed.

The other reason why I did not want an epidural is because I wanted to avoid spinal headaches.  This is not common, but I personally suffered from headaches since I was in high school and I worked really hard to keep them at bay naturally. I know how debilitating they are and I know how important the initial mother-child bonding is.  I did not want to be distracted by headaches. Another symptom that can occur is low back pain around the injection site.  I have treated a lot of patients who have had issues with their injection sites and it includes low back pain in the area and radicular pain, which can come down from that area down into the hips and the leg area. 

The other thing with epidurals that I am concerned about is the actual birthing process. There are other types of epidurals that are less intense such as a walking epidural where you can still move, change positions, and be more mobile while laboring. However, the typical epidural results in you being confined to the bed and you are not allowed to move around. In a biomechanical standpoint, that is not the most efficient way to deliver as you are not using gravity and you are not allowing the shifting and moving of the pelvis for baby to navigate his way out. Babies do not just come out head down and come right out. They have to maneuver around the pelvis and make some turns. Sometimes, being able to shift the pelvis and opening different spaces helps to navigate those turns and it is more difficult to do that when you are confined to the bed.

One thing that I tell all of my patients who have the mindset that they will have an epidural to have a pain-free birth is that it is important to realize that epidurals do not always work. You need to be prepared for delivering without an epidural in case you get there late and they do not have time to do one, or if they do it and it simply does not work, or if only half of it works. There are different scenarios where you might not have that pain-free birth that you have in your mind.  It is super important to know the other ways to deliver in case something goes wrong. You also should be knowledgeable about the steps of a C-section surgery in case you have to have one so you know what is going to happen, what it is going to look like, and how recovery will be for you. You have to be well-versed on the different things that might happen because that will make it as stress-free as possible. It will be stressful no matter what, but you need to take steps to reduce the stress through being well-versed and educated to put your mind at ease.

When I hear stories from my patients that they have pushed for two or three hours, I find it wild because you should be using the uterine ejection reflex to get the baby out. Your body should be doing it for you, so that would be the other thing with an epidural. Just because you are 10 cm dilated, it does not mean that it is time to push. If your baby’s heart is decelling and it’s either get the baby out now before you are ready physically or have to have a C-section, then you will be pushing when you are not physiologically ready. You will be using all that effort to accomplish what your body is not ready to do. For me, it was an ebb and flow of small ones that I could rest through, and bigger ones that I would allow my body to do the pushing down of the baby. It was a back and forth until the baby’s head was basically out.

I think it is super important to let the steps happen naturally.  If you push too early, think about the trauma to your pelvic floor. You have to know if the baby is already fully engaged and if you are at the right station. Your pushing should not occur until you cannot possibly resist the urge to push anymore. 

Also, a weird side effect of epidural is when it does not wear off. I had a patient who had a vaginal birth and had an epidural and when she went home, she could not walk. She had a toddler and the newborn baby to tend and was not able to take care of both of them or herself. She was only able to regain the ability to walk over the course of a few months.

A Patient’s Story Regarding Epidural

I had a patient who had her first pregnancy and she was super fit and healthy. Her pregnancy was a walk in the park. She measured small regarding her fundal height. Fundal height is one of the ways your progress is measured during your pregnancy using a measuring tape from your pubic bone to the top of your uterus. Her ultrasound also showed that she was measuring small. All signs pointed to maybe her due date was off.

Her doctors and midwives decided to induce her when she was one week over her due date even though they knew she was measuring small. She was not close to being ready to deliver, but they still had her come in and gave her Cervidil, which helps soften the cervix.  This is another sign that you are not ready to deliver.   They also gave her Pitocin and she labored for hours. Around nine hours passed and she still had not dilated past 3 or 4 cm. She was exhausted and decided to get an epidural for the pain. Her labor stalled.  They had to increase the Pitocin again.  The stress caused the baby’s heart to decell. They were ready to do a C-section if she couldn’t push.  This is where pushing before you are truly ready wrecks you, leaves you exhausted beyond measure, and doesn’t let your body do its own thing.  She was lucky because she is healthy and fit and it worked out eventually. She pushed for hours until the baby came, but they still had to do an episiotomy and use a vacuum. What would have happened if she was not as healthy and active? It might have transitioned into a C-section so that is where the increase in the possibility of a C-section happening.

Data Surrounding C-Section In The United States

I just want to go over some numbers with you as to the C-section rates in the US. We are numb to the frequency of C-sections.  Just because we are used to C-sections being commonplace does not make them any less extensive of a surgery.  

In 2019, the United States’ numbers for C-section are 31.7 percent. Some may say the numbers are made up of older moms, breech babies, or the like. When you look at the actual numbers, however, you can see that 25.6 percent of all births that are low-risk are also C-sections. Low-risk pertains to new moms, single babies, the baby is in full-term, and the baby is in a head down position. 

Maternal mortality rate increases FIVE times higher in people who have C-sections. It is a major surgery and it has more complications (like death) if you undergo one. If you are aware of mortality rates in the United States, the rate is 17.4 deaths per 100,000 live births. In New Zealand, it is 1.7, Norway is 1.8, and Canada is 8.6. In Black and non-Hispanic women, the mortality rate is 37.1. Obviously, something has to change in the way we care for pregnant women to have better outcomes.

The short answer is that I skipped on an epidural because I did not want a C-section and they are most certainly related. 

If you have any questions, you can drop it in the comment section or you send me a message through Facebook or Instagram. I’d be happy to do another podcast about your questions. Also, if you want me to talk about something specific, let me know!

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Thank you for listening and see you next week!