The labor epidural is the safest and most effective method of relieving pain during labor. Dr. Walker and Dr. Shakespeare have considerable experience with epidurals and are among the very few obstetricians who were trained to place epidurals during their residency. Based on the thousands of epidurals that they have managed, they can attest to the safety and effectiveness of this procedure.
The alternate pain medication available to laboring patients is IV narcotic therapy which crosses the placenta and can depress the infant. This can require resuscitation to help the baby breath after delivery and increase the cesarean section rates because of abnormal changes to the fetal heart rate. The patient can also be disoriented secondary to the effects of the narcotic and not respond appropriately to instructions. The epidural doesn’t appreciably affect either of these with the rare exception that it can temporarily lower blood pressure causing momentary changes to the fetal heart rate which can quickly be corrected with medication.
Women who have delivered with an epidural often blame persistent back pain following delivery on the epidural. One of the worst things a woman can do if she has a bad back is get pregnant. The curvature of the spine changes during pregnancy and the growing infant and enlarged uterus are pressing on the nerves and muscles of the back for many months. This is the reason women complain of back pain following delivery. It would be very unusual for the epidural, which is actually a form of treatment for people who have back problems, to be the cause of anything permanent or long lasting.
In our experience, the epidural greatly increases the safety of the delivery itself. We feel that the benefits of a labor epidural include:
- Decreased risk of vaginal, 2nd, 3rd and 4th-degree lacerations since the delivery is usually more controlled than those without any anesthesia.
- Decreased cesarean section rates since it relaxes the tension in your muscles. It also allows us to turn the infant in the vaginal canal if it is looking up to the sky (OP position or “sunny side up”). Infants that are in this position don’t fit as well through the birth canal, and our ability to turn the infant, so it is looking toward the ground (OA position) greatly increases the chances you will deliver vaginally. This maneuver is much easier and more effective with an epidural.
- Decreased risk of postpartum hemorrhage since it is much easier and effective for us to massage and compress the uterus after delivery if you are bleeding from an atonic, boggy uterus.
- Decreased risk of bleeding and retained pieces of placenta after delivery since retained placentas are more effectively managed with anesthesia levels only attainable with an epidural. Occasionally, sharp metal curettes are required to remove adherent pieces of placenta and membranes following delivery. This can be extremely painful without an epidural. Your chances of being sent home with pieces of placenta still stuck inside your uterus are greater if you have to undergo a manual placenta extraction or uterine curettage without an epidural.
- Vacuum-assisted vaginal deliveries are sometimes the quickest way to deliver an infant when there is a significant deceleration of the fetal heart rate. This procedure is usually easier and safer to perform on patients who have epidurals.
- There have been reports of patients pushing so forcefully at the delivery that the infant has landed on the delivery room floor. This is very unlikely to happen if you have an epidural. Not only will the pushing be generally accomplished with greater control, but if you progress really fast during labor, the doctor has a better chance of making it to your delivery. It is always safer for you and your baby if the doctor can be present for your delivery.
All of these complications can occur during any labor or delivery and are often unexpected. It can be very difficult for patients to remain still during these emergencies and tolerate the discomfort of these procedures without the benefits of the pain relief provided by an epidural. When it is difficult for patients to tolerate, it is more challenging for us to perform the necessary procedures needed to accomplish the safest outcome for you and your baby.
If you have any further questions regarding the risks vs. benefits of labor epidurals, please ask us during your pregnancy. Ultimately, it is your decision, and only yours, if you want a labor epidural. Our job is to allow you to make a fully informed decision based on the facts described above.