Practioner Feedback
Thank you Kim for the very relevant information on epidurals. As ICAN president, doula, childbirth educator and mother of three sons, I applaud the information you have gathered!
In reading through your site I think it would be great to see the information on maternal fever included in the Baby Side Effects as so many babies are subjected to unnecessary septic workups and subsequent antibiotics based soley on the increased maternal temp caused by the epidural. This my clients find the most distressing because of the often mandatory mother-baby seperation in order to "monitor" baby and the unnecessary procedures and medications they recieve prophilactically. Personally, I find significantly more than 15% of women developing epidural fevers after 4 hours :-(
I also have a request. Could I link to your site from the sites below? Could I also use the information (with full credit to you) for childbirth classes and doula clients? I believe *all* women should have the information you provide available to them!
Again BRAVO!
I am a Labor and Delivery nurse, I have seen such an increase in the use of epidurals even in the last 2 years. I find that women tend to be in one of two groups either those who want an epidural at the first contraction that they feel or those that feel that an epidural is the absolute worst thing that they could do and that they would be a total failure if they had one. I feel very strongly that epidurals are very useful and for some women very necessary. I have heard from some women that if they have an epidural thry will be having a c-section. There may be a connection between c-sections and epidurals but we also need to look at the sizes of the babies and the shape of these women's pelvis' before we blame the epidural. I know of many different doctors who will let a woman continue in labor as long as the baby and mom are okay longer with an epidural than without. We need to give women all the information not just all the bad and not just all good, but we need to make women able to make their own informed decsions.
I too found your site VERY informative and helpful. With an epidural rate in my area of 98%, most women have decided they want one. I've been to the childbirth classes in the area though and NONE of the potential complications are discussed. UGH! I will be putting your site in my list
I particularly liked your site because in my area over 80% of women choose epidurals. Your site is balanced and helps women to minimize the risks and complication to improve their outcome. Our local anesthesiologists still say there are no complications for the labor or the baby so women are not getting the information they need to help themselves. You certainly can use the information I sent you. I'll keep checking out your site to see what you've done. i'm sure it will be great.
Very informative. Great Job. As a doula, I find it hard to get so much neutral info on Epidurals. It seems that info available is either pro or con. Thanks you for being so through.
This is an excellent new site for women who want the epidural. I personally don't recommend the epidural in most cases - so don't get me wrong. But I also know that many women DO choose to get it and so my goal is to help women know what the risks are and how they may avoid some of those risks. This was written by a doula and I think she gives the information in a non-threatening and very helpful manner.
I think your website is a wonderful source of information on websites. I'm teaching a class at Babies R Us later this month and am putting together some resources. I would love to list your website as a resource for epidural information if that would be okay with you.*
I just read some of your great site on epidural anesthesia. Wow, you have obviously put a ton of work into it, and your writing is excellent as well - it's very clear, and your backing up of everything with references is invaluable! Thanks so much for doing this! I can see already from the feedback on your site that what you have created is already so valuable to many people.
I would like to suggest one more addition to the maternal risk factors for epidurals: the risk of permanent disability. At this site:
http://www.healing-arts.org/mehl-madrona/mmepidural.htm#permanent
...is a discussion of the possibility of paralysis and other serious nerve damage. Thankfully, these risks are rare overall, but they still exist. I heard about this type of severe complication from my mother, who is an adjustor for a medical malpractice insurance company. Her company had a case involving a woman who walked into the hospital to have her baby, had her epidural, and came out in a wheelchair, to which she is now confined for life. It seems to me that many women see only the rosy picture of epidurals as portrayed on TV on shows such as "A Baby Story" - the mother is instantly transformed from a state of inconsolable agony to one of giggling bliss and absolute adoration of the anesthesiologist.
I am very glad you have created your site to give a more realistic picture of the side effects, risks, and possible further interventions that may occur with an epidural, and that you have so clearly and effectively outlined how mothers can best avoid these negative aspects of epidurals. It is crucial that anyone undergoing a medical procedure, particularly one as serious as an epidural, have truly INFORMED consent - knowledge of what is likely to happen to them as a result, not just a fantasy that everything will magically turn out fine for them, just because it has for all their friends and the women they see on tv. That's a recipe for disappointment - side effects and disastrous complications happen to women every day, and too often they are left feeling cheated, that no one warned them that this could happen to them. If they know ahead of time what to expect, what the risks are that they're taking, and how to minimize the ones that are within their control, they and their babies will surely end up with better outcomes - healthier, happier, and more in control of their own health. My personal hope is that perhaps more women will choose to delay or avoid the epidural entirely - to focus on ensuring that they get the supportive birthing environment they deserve, learning non-medical coping techniques in labor, and working with their bodies instead of merely feeling like victims of their bodies. These activities carry no risk or infinitessimal risk when compared to epidurals. And mothers may find they have a more satisfying birth this way, as well! (Not to mention an easier recovery).
I am an aspiring doula who will finally be attending formal training in a couple of weeks, and I'm sure I will be referring to your excellent page on a regular basis, both for my own knowledge and also that of the mothers I am seeking to assist in birth.
When I had my daughter in the hospital almost two years ago, I was dead-set against having an epidural, unless ABSOLUTELY necessary. I was thrilled to be able to go through labor with only one foreign substance entering my body, the only one I wanted: water. I even avoided an IV. I experienced a tremendous amount of pain, of course, but I knew it had a purpose, and that it was part of a natural process that was the safest and most beneficial way for my baby to be born, so somehow I managed to stick it out. It sure wasn't easy, but who ever said birth was supposed to be easy? I was able to achieve the type of birth I wanted, and I count myself fortunate to have had that opportunity.
Looking at the tables of risks you present for epidurals, I find I am even more against ever having one for myself - of course unless absolutely necessary. The risks are just not worth it for me (and of course I respect the right of other mothers to choose differently for themselves). And though a scenario requiring me to have an epidural is thankfully extremely rare, if I ever do have to get one, I'll know how best to avoid negative complications, thanks to your site. Thanks again for all your hard work - it is of excellent quality and much appreciated!
Feedback from mothers who have had, or are considering epidural anesthesia.
I had an epidural with Hailey and my labor also slowed. I also experienced very extreme vaginal pain even with the epidural and when they gave me more medication by blood pressure dropped and I crashed a bit. Even though, I don't think it was the best epidural given I would have it again because it did help tremdously with the contraction pain. I did have pain at the end though when pushing which I hear is very normal
I also had an epi with my daughter-but I seem to be the opposite of the other ladies! My labor actually sped up after receiving it I went from 5 to 10 cm in about 15 minutes after I got mine. I had not decided I was definately going to have one, but decided I would if needed! It helped me tremendously through the pushing process
I'm considering an epidural, and this was very helpful, Kim. Thanks!
I would rather go with what is called an Intrathecal. it is given in the same way as an epidural but you are allowed to walk around during labor. You can feel the contractions but the pain is not there. you know when to push. This is not deadened at all. I was very pleased with this. I had an epidural with my first and I really did not like it. This Intrathecal was like a dream. The only side affect is itching. Which goes away after it wears off.this was a small side affect for me. Otherwise it was great. It really gave me alot of freedom to move etc. I hope this helps anyone out there looking for different methods of pain relief. Ask your DR about this one!
That was all very good information. Thank you so much. I had an epi with my first child and my labor slowed. I have not completely ruled out an epi for this time around but I will not be so quick to get it. I plan to wait as long as possible before asking for it. My husband agrees with me. He would like me to go all natural. I would love to but I'm going to have everyone on notice that if I decide I want it, I want it to be ready. Again, thanks for all the great info.
The article says that most women who get epidurals will have to have pitocin. This was not my experience, nor was it the experience of any of the women I know who have had epidurals. It seems that the article has the causality reversed, as in most people who get petocin will choose and epidural, but not that most women who get the epidural will get petocin. I am not a health care provider, so my experience here is limited. So, I was hoping you could clear this up for me.
I had my own epidrual at about 5 1/2 centimeters, and it appeared to speed up my labor. I had some difficulty pushing, and they ended up using a vaccum extractor to help me get my daughter out. over all, I consider the rest I got for a couple of hours to justify my reliance on the epidural.
I had my first baby on August 15,2000. My labor went very fast. I was planning on trying to "tough it out", but once I got to 6cm. I was begging for the epi! The "epi doctor" was very friendly, informative, and reassuring! After getting the epi, I was much more relaxed and even wanted to get some sleep before having to push. My daughter was so anxious to get out and meet us, that I didn't get the chance to sleep! I am definitely all for the epi with my next baby if needed!
I adored it! lol..i went in with the 'i'll see what i can do' attitude...after 9 hours of labor (a lot of that spent in the shower...who was my ONLY friend haha) i finally had had enough and asked for the epidural around midnight...i made sure to turn every hour from one side to the other so that dialation would say even and not freeze up on me since i was now in bed instead of walking around with gravities help..it must have helped..along with the relaxation the epi brough me ( i was scared stiff it being my first labor and not at all the 'discomfort' described by the books ) and my son was born 3 hours later and with just 15 mins of pushing..they also stopped the meds once i reached 9.5-10 cm so i had pretty much full feeling back for the pushing wich i think helped a GREAT deal Wendy Jeramiah 8/2/98 hospital/epi Jonathan 12/1/99 hospital/unmed
I had an epidural for the birth of my daughter. It was a God - send. I had planned on not using meds but I had a very long labor experience and was completely exhausted. I was able to sleep and get my energy back. I had no side effect from the epidural. In fact, prior to my epidural I had been given a shot of Morphine to try and relax me and regulate my contractions (they were 7min, 3min,5min, 2min)it worked. After that had worn off in about 8 hours, I was given an epi. when I was 5 cm. dialated. It didn't hurt at all, you only feel a little shot where they numb you to administer the epi.. I had just enough discomfort to know when I had to push. My baby weiged 9lbs 6oz. with a 14 1/4 inch circum. head. I had to have an episiotomy, it was not bad at all. One thing I would recommened is to get up an move as soon as you are able to. Once the doctor had left my birthing room, the nurse helped me walk to the shower. I sat in the shower for about 20 minutes and got cleaned up. I tried to function as normally as possible. I walked to my bed and to and from the nursery. I really believe that getting up and at-em played a tremendous role in my recovery. I can honestly say I felt like a million. I did have a fear of an epidural and after I had it I don't even know what I was afraid of.
I had gone through my first labor without any pain relief,
in spite of being on pitocin. It was pretty long and grueling, with about 2 hours
of pushing and I ended up with a bad tear (30 stitches), and lost a lot of blood.
(I did have a doula, by the way, and she was great, but not every birth goes according
to the natural birth textbooks.)
For my second birth I went 9 hours without pain relief, again on pitocin since I don't seem to go into labor naturally. I had a doula for this birth, too, but after 9 hours I decided I really couldn't take it any more. The baby was still very high in my pelvis and I had no idea how much longer I would have to hold out. The pain seemed much worse than the first time. Well, I opted for an epidural and my 9 1/2 pound son was born less than an hour later--the doctor barely made it in time. I pushed for about 10 minutes and had 4 small stitches.
So it was the epidural that "enhanced" my experience. I'll never forget the relief of being without pain while my son was born. If I go through birth again, I still intend for it to be as natural as possible, but I will not hesitate to get an epidural if I feel I need it. It had absolutely no effect on the baby--his Apgars were 9 and 10. I could move my legs, support my own weight and feel (painlessly) when a contraction was coming on so that I could push effectively. Within an hour after the birth I could stand well enough to be moved to another room.
I'm all for learning about the birth process and avoiding overly medicalizing it.
But I really think that the demonizing of modern hospitals births can get out of
hand.
One of the things I noticed on your site was about the maternal backache. Someone told me that the backache (which I had for a LOOOOOOoooooong time) could be caused by the tiny bump of scar tissue into the epidural space, and that by massaging the the spot firmly, the backache would be releived (the scar eventually shrinks on its own, ending the pain). Sure enough, a firm massage with a thumb between the knobs of the spine, and RELEIF! it felt itchy, there, too, though I never noticed until DH started massaging it. Massaging the scar site may also shorten how long the scar-related backache lasts. You can hire a chiropractor to do the same thing, if your partner doesn't do it right. (wait until the site is healed, first!)
I labored 66 hours with no meds, then 12 hours with epidural, before my son was born. He was in great shape (9/10, nursed well), and I had no tears or stitches (only skid marks, apparently caused by his ears, since he was born with his ears folded down and full of blood - poor kid). Midwife-managed birth, with two doulas! (hooray for doulas!) :) And honestly, I was nearly gone from lack of sleep (hadn't slept all day before labor started, either, so that was like 78 hours with no sleep at all...). The epidural saved me from a c-section.
The other thing we noted was that my son's heart rate began to destabilize (though fortunately not very much) at the same time that my legs started to get numb and cold. My doulas massaged my legs, and every time they did, his heart rate stabilized again. SO they kept massaging and massaging and massaging... even though I couldn't feel it, the results show up on the monitor strip.
Glad there are people out there who support exploring - and taking charge of - all the options. I'm aiming for no meds the next time, but as one of my doulas said, there is no way to know in advance whether you will have more pain than you can manage, or less, you just have to be prepared for anything and roll with it as it goes.
For my first birth- I had everything planned out- I wanted to have an epidural (the walking type)etc- when I was induced into labor with pit for my water breaking/overdue baby- I got stadol and when they said I could have the epidural- I didn't want it- I didn't feel that I needed it. Had my labor lasted longer or the birth was more difficult, maybe I would have had the epidural but my labor was fast and short (4 1/2 hours). For my 2nd labor I plan to have things the same- opportunity for the epidural if I want it but if I don't need it- great. I think knowing that I could have it was important. Also I have found that some drs. will give you the epidural but let it wear off for the pushing part which can be painful and some will let you get it at 10 cm. So be sure you know at what point your give it and when he lets it wear off. you might decide to skip it.
I've had two epidurals. I am now preg with #3. I loved the epidurals...but sometimes when I am carrying one of my children I will feel what I describe as "shocks" at the site of my epidural! It really throws me for a loop! A friend told me that hers aches when it is damp and rainy. I was wondering if anyone else had these feelings...especially that WEIRD "shock" feeling!!!!
I am a needle phobe (big time) & had gone through the entire pregnancy without a single blood test. & was determined to have no needles at all during labour
I had an epidural, & I could have kissed the anithsetist once he had done it. Having the needle was no where near as bad as I thought it was going to be. I had been in labour for 37 hours & it let me have some sleep. I went from 5 to 10 cms completely pain free.... Fantastic.
It was very odd though, I could move my right leg but my left was as though it wasnt mine - couldnt feel it or move it at all. I was cross in one way - as soon as I had it they stopped me from eating & drinking except for water & I was dying for a cup of tea - well, us English are renowned for drinking tea :-)!
Thanks for the information. I had an epidural with my son after several hours of walking around - by that point I was ready to be in bed! My labor speeded up after I received the epi - I was dilated 6cm at the time, and things seemed to go really fast after that! I think that may be because I am a wimp with pain and I was not relaxing well between ctx, so the epi helped me relax and speed things up. The only thing that wasn't great was that it took more on one side than the other (I lost all the feeling in my right leg for a while!) but it was worth it! I could still feel the ctx, and knew when to push and everything. I will definately have an epi with this one, too!
Great info Kim! I have had 2 epidurals (both with pitocin) and one drug free due to fast labor- there just wasn't enough time for the epi. I enjoyed the epidurals because I felt in control of my labor and enjoyed the experience. With the drug free birth, I felt out of control during labor, but felt wonderful afterwards. The down fall with the epidural was that I couldn't move into different positions. I always thought I had to stay on my back due to the paralysis of my lower body. To read that it is possible to move into different positions really excited me and I plan on talking it over with my midwife at my next appointment.
Thanks so much!
Thanks for the information!
Great info!!! Thanks!
I always hesitate to admit that to expecting moms - or at least first-timers - because I don't want to scare them. But on the other hand, I think that so often the epi is held out as the holy grail, the one thing that will make all the pain go away and insure a wonderful birth experience, and so it's extra disappointing if it doesn't work. And I'm not the only one this happened to - I know of at least two other women who had the same experience. In my case, the anesthesiologist had a little trouble placing the needle, but finally got it in the correct space (he thought) and started the medication. Nothing - no pain relief, no numbness in my legs, etc. He told me to give it some time (even though I had been told relief would be immediate). So we waited a while. Nothing. He increased the dose. Nothing. Waited, then increased the dose a final time. Nothing. He said he couldn't give me any more. It never did work. But meanwhile, because of the epi - even though it wasn't helping - I had to have a catheter, I had to have an automatic blood pressure monitor, I had to have an IV in case the epi caused low blood pressure, and I was of course stuck in bed and couldn't move around much. During the birth, my doctor did an episiotomy and didn't give me any local during that OR during the stitches after, assuming that the epi meant it wasn't needed, but I felt it all! Then, when labor was over, I wasn't able to get up and shower for 24 hours because they were worried about my falling in the shower (I forget if it was because they thought my legs were numb - which they never were - or because of the possibility of low blood pressure). It was all so disappointing! I mean, I went in hoping for an unmedicated birth, stood it for as long as I could before asking for an epidural, and then when the epidural didn't work I was just crushed. I think if moms are going to be offered an epidural, they need to know ALL the interventions that typically go along with it, AND they should know that there's a tiny possibility that it won't work - just so that they can be mentally prepared. JMHO!
PS - I'm expecting baby #4. #2 and #3 were both unmedicated, and I plan to do it that way again. But who knows? If I thought it would work for SURE, I would give an epi another try. *LOL* *
My first birth was 7years ago...no education....and VERY fast labor(3hours) but was staying with my family and couldnt get anyone to believe I was actually in hard labor until I started bleeding. By the time they finally got me to the hospital, I was freaking out and the baby was crowned, but my water hadnt broken. This was a very traumatic experience for me and I had wanted pain meds but had no time.
My second birth was 4 months ago(8-29-00) and induced. I had decided that since they say labors get shorter with each baby, and I had done it without pain meds before, that I could automatically do it again without meds. Plus, I was more educated, knew what to expect, etc. Things dont always work out how you think they will. LOL The hospital started my pitocin at 7:15. About 15 minutes later, my contractions came on immediately as hard as they get... and 3-4 minutes apart. I was pleased, handling it quite well...not shrieking...moaning like a cow or something LOL. I dialated pretty well....4 cm in less than 1/2 hour. However, since I was getting these contractions so close together, I told the nurse I wanted something in my IV to "take the edge off and let me relax" She refused....doc said it was up to the labor nurse. She refused because she thought I only had about 1/2 hour-45 minutes left before delivery. I understood and talked myself into "I can handle this that long". 1/2hour..... 45minutes.... 1hour..... 2hours .... still no baby and no more dialation....but the contractions were closer together..... less than 2 minutes apart... NO relief in sight. Again, nurse said nothing in my IV an Epidural was my only option. Well, I wanted some relief since it looked like this was going to go on for awhile yet. I told her to call the anesthesiologist. He came in around 11 and told me he could get the epidural in around 11:30. He left.....came back about 11:20 and announced we were going to sit me up (which increased my contraction pain) and wait for "in between contractions" and that he'd have it in in about 15 minutes. Nurse checked me again....still no more dialation. Nurse told him there was no time between contractions.....so he called some others to hold me still while he put in the epidural through contractions. He got that eipdural in and Iimmediately felt a dramatic decrease in pain... then came the fire....I had a "fire" pain which wouldnt go away in my lower right abdomen....whatever, I could deal with fire better than the close contractions. Everybody except my husband left. About 10 minutes later, I could feel the baby coming down the canal...I told my husband to call the nurse....she quite haughtily said to him "honey, it's ONLY been a couple of minutes" my dh hung up the pager thingy. My eyes about popped out of my head and I told him PAGE her AGAIN.....he says "we need helllllp" when she answered and she came right in acting all "put out" or something. But, when she checked me, she looked at me eyes wide and said "you're completely dialated DONT PUSH I'm calling the doctor" Doc was close,luckily....and with just 3 pushes my little dd was born.
Afterwards, they told me that before the eipdural, I was probably "fighting" the contractions...and the epidural relaxed me enough to allow dialation.
I do have to say that with this one (yes, I'm pg again)... I think I will ask for an epidural when they'll allow it and the pain is bad*
I had 2 epidurals... one of them my B/P bottomed- but with the drug to counteract this and some quick positioning I was fine and the baby was fine. Both epi- babies were delived vaginally without complications. The labors weren't necessarily any longer than they would have been for me othewise and pushing was short and although not painless it was controllable.
I am going to try HARD NOT to have an epidural. I had thought that I probably would before going to my childbirth class, but since then, I've changed my mind. Why?
1. I don't want to be chained to my bed...my hospital requires you to stay bedridden with an epi. I want to walk, sway, move, change positions, etc.
2. CATHETERS! My hospital also requires you to be catheterized, sometimes redoing it every 2 hours...YUCK!
3. I think I may be able to do this without... I know the pain won't last forever, and I've been through severe pain in my life before without meds...it was no picnic, mind you, but I did it.
I'm not totally ruling out an epi, but I'm going to fight having one really hard.**
My main reason for wanting to avoid an epidural (and any other interventions) if I can, is to reduce the risk of "cascading interventions" that often lead to c-section. But I also share your concern about restriction of movement and catheters.
Once I started reading about the phenomenom of cacading interventions it sounded sooooo familiar - why? Because it sounds like so many of my friend's birth stories.
They get to the hospital and they first get offered some narcotics (Stadol, etc) just to "take the edge" off labor. The hospital makes them stay in bed once they take anything because they're a little woozy (liability concerns about falling) so now they don't get the natural relief of walking, standing, changing positions... Worse yet the drugs makes their own body stop naturally producing any endorphins to help with labor pain so when the narcotic begins to wear off, the pain seems even worse than before. So they get some more, but each time they become more sensitive to how it begins to feel as it wears off and they get anxious more quickly about the returning pain. So they proceed to get an epidural as soon as possible. This means they are even further restricted to bed. The epidural causes their labor to slow down. Next they inevitably get a pitocin drip. Now they start having the unnaturally hard contractions caused by pitocin and that causes the baby to go into distress. Furthermore the baby isn't descending very well because the epidural has diminished their natural muscle activity that would move the baby down (not to mention the walking or change of positions that would have helped this). So what comes next? C-section!
I realize that this is not everyone's experience and I think epidurals in the right circumstance can be fantastic and helpful. Like we've heard here, if Mom is just exhausted or too tense and fearful of the pain, an epi can help her relax and make labor go faster and easier. I just think the slide towards c-section is so commmon that I will do everything I can to avoid, or at least delay as long as possible, getting any sort of pain relief. But I have not been through it and I am not presumptuous enough to think that I can say now what I will want or need during labor. All I can do is try and I think I want to.
Kim - I greatly appreciate you posting this article. I have sent it to my labor support team. It is very well written and very balanced. I wish you were a doula in the San Fran area.**
When my labor slowed my son got stuck for a long time. Perhaps it was the doctor I had. I think he should have taken my son by c-section way before. After being in there so long, when they finally did get him out, his face was grey and they couldn't get him breathing right away. He ended up having pnemonia and had to stay in the hospital for 9 days after delivery. He also has asthma. Now, I don't know if any of these things are related and I don't know if they have anything to do with him being stuck in there for so long but for me I'd rather be in pain and hear that sweet cry immediately after the baby is born than risk them having to take the measures they took last time. This has nothing to do with me thinking I'm so brave or I'm super mom. I'm not ruling out an epi completely, I just won't get it the second they say I can. The one experience I have had with an epi was not a great one and I'd like to avoid it if I can.
Thanks for visiting! Please email me with your thoughts, suggestions and other pertinent feedback:
Kim Palena James, CD(PALS)
Seattle, WA