[My apologies to anyone who has read this post in its horribly-formattedness...hope this is better]
then you should know the risks. An anaesthesiologist will probably not list and discuss these with you before letting you decide whether or not to have it - and the middle of labor is not a time to process information well. Whatever choice you make, it's better to understand the benefits (it hurts less), consider the risks (some are listed below), discuss it with your doctor or midwife, make a decision and then discuss it with your practitioner again :) so everyone is clear, before you go into labor.
The following chart lists only the possible complications to the progress of the labor, not for either the mother or the baby; those may be found at Seattle-area doula Kim James' site at http://www.kimjames.net/epidural_risks_and_side_effects.htm, from which this chart is taken (and at which you may find her sources of information).
| Risks and/or side effects | How often this happens | Why is this a problem? | What you can do |
| Prolonged 1st stage of labor (while your cervix is dilating; usually the longest stage by far) | Common[30] | The anesthetic in epidurals weakens all the muscles below the epidural site. This can dampen the strength of uterine contractions. · Can be exhausting, boring, or otherwise discouraging for both mother and father. · Greater use of Pitocin needed to strengthen contractions can be stressful on baby and/or uterus, which may lead to cesarean section.· Greater incidence of maternal fever. | ·Give labor time to happen. The risks increase the longer Pitocin and epidural anesthesia are in your system. However, as long as mother and baby are doing well, allow time for labor to work. Do not accept arbitrary time limits. There is no “magic amount of time” for labor to be finished. · Ask your nurse and care provider for reassurances that you and the baby are well. · Negotiate with your care provider, before labor happens, how long you’ll be able to labor. Find out when your care provider will begin suggesting cesarean section for failure to progress |
| Increase of malpresentation of baby’s head (the baby's head doesn't come into the pelvis at the best angle; lengthens the pushing stage) | 20%-26%[31] | · Relaxation of the pelvic diaphragm predisposes malpresentations, as does lack of mobility and switching positions. | · Choose a CSE or intrathecal epidural. · Wait until baby is very low in pelvis (at least +1 or +2 station) before requesting epidural. · Wait until at least 5 cms dilation before requesting epidural |
| Increases the need for Pitocin augmentation. | Almost always, especially if epidural is given before 5 cms.[32] | · Some babies simply do not tolerate pitocin-induced contractions, the result being abnormal fetal heart rate after administration of pitocin. · Abnormal fetal heart rate may necessitate an emergency c-section. · Pitocin has a myriad of side effects. Please see Epidurals and pitocin below. | · Refuse an induction and wait to go into labor on your own unless the risks of continuing the pregnancy outweigh the risks of induction. · Wait until 5 cms dilation before requesting an epidural. Give your body a change to establish labor on its own and you’re less likely to need augmentation. · Ask your care provider to wait at least 2 hours before Pitocin is started to give your body a chance to adjust to the epidural. · Your body must also process the IV fluids that were administered before the epidural. That much fluid very often dilutes the oxytocin in your body, resulting in weaker, spaced out contractions. Give your body a chance to process the excess IV fluid and catch up. · You may want to practice active visualizations in an effort to speed up your own oxytocin production. |
| Prolonged 2nd stage of labor (pushing stage) | Especially true for first time mothers [33] | · May go against some care providers’ philosophy (ex: 2nd stage must be finished in 2 hours). | · Wait to start pushing until the baby’s head is visible on the perineum. · Negotiate with your care provider, before labor begins, how long you’ll be allowed to push. Find out when your care provider will being considering forceps or vacuum extraction or cesarean section for failure to progress. · Change positions and use downward gravity to help push your baby out. · Again, stay off your back. |
| Decrease in the ability to push effectively | Common[34] | · The build up of anesthetic simply weakens muscles to the point of ineffectiveness. · Mother may be able to push a little, but may not be able to effectively help the baby to rotate and descend. · Leads to increase in operative delivery.· The build up of anesthetic simply weakens muscles to the point of ineffectiveness. ·· Leads to increase in operative delivery. | · See above. |
| Increased likelihood of forceps or vacuum extraction delivery | Five-times greater likelihood.[35] | · Less efficient uterine contractions may keep baby from rotating naturally, and the diminished urge to push may keep baby from coming down. · Muscle weakness may not allow mother to push effectively. | · Consider letting the epidural wear off for pushing. · Don’t request an epidural until at least 5 cms. The fewer hours the epidural anesthesia is in your system, the less muscle weakness you’ll have to contend with. |
| Increases the likelihood of needing an episiotomy[36] | Depends on care provider philosophy | · Goes hand-in-hand with increased use of forceps and vacuum extraction. · Episiotomies are far more likely to tear beyond the original incision. · Take longer to heal, with greater scar tissue, than natural tears. · More postpartum pain for the mother. | · Talk to your care provider about their philosophy towards episiotomies. Find out when they are most likely to cut an episiotomy and how often this happens in their practice. · Strengthen your pelvic floor muscles before labor. |
| Increase in cesarean section | 50% if you get the epidural when your cervix is dilated to 2 cm; 33% 3 cm; 26% 4 cm; | · Cesarean section deliveries carry far more risk to both the mother and baby than vaginal births do. · Mother may feel cheated out of a vaginal birth experience. · Postpartum recovery time is significantly longer than a vaginal birth. | · Don’t request an epidural until at least 5 cms. dilation. This will give you the greatest opportunity to get labor established on your own and to be upright and active. |
Nutshell: The epidural is almost never medically necessary, BUT if you must have one, here's what you can do to minimize negative side effects:
- Keep changing positions and stay off your back.
- Labor at home as long as you can before heading into the hospital; this makes Pitocin augmentation, which causes unnaturally strong pain, less likely.
- Wait till your cervix is dilated to 5cm.
- Let it wear off during pushing (2nd stage of labor). This also helps avoid side effects to the baby.
A basic principle for all labor pain-relief techniques is that, in general, what makes it hurt less (i.e. epidural, horizontal positions) slows it down and what makes it hurt more (i.e. upright positions, Pitocin) speeds it up. The main exception to this is the fear-tension-pain cycle - if you reduce fear/tension, you will experience less pain and your labor will also be faster. More on that later, it's important...
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