Epidural vs. No epidural in labor? Tips to help you decide!

So yes I did it not once, not twice but three times. I initially did it with my first because I wanted to see what it felt it. I wanted to be able to tell my patients what to expect and be able to relate to them when a lady comes in screaming her head off. Now I know why! And BTW, it’s ok to scream, cuss, etc. Just watch the kicking!

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So let’s get down to it!

Benefits with an epidural:

little to no pain depending on how well it is working (or as my RNs call it a "Happy-dural")! Yay!

Risks with an epidural:

• Hypotension or low blood pressure that could affect baby's heart rate 

• Pruritis or itching

• Urinary retention or inability to void sometimes requiring a foley 

• Fever and shivering
  

• Post-dural puncture headache- a positional headache (ie, worse when the patient sits or stands) that occurs because of leakage of cerebrospinal fluid (CSF) through a dural puncture with incidence of 1.5%.

• Backache- localized back pain related to tissue trauma at the site of a neuraxial procedure may be present for several days, but prospective studies have consistently reported NO correlation between neuraxial analgesia and long term back ache. I hear about this all the time!

• Postpartum neuropathy- neurologic complications associated with neuraxial anesthesia are extremely rare but this would be issues with numbness or inability to move legs for extended periods of time. It is so rare that studies can’t even quote an incidence rate and in 7 years of private practice, I have never seen a serious complication. Transient symptoms yes, but nothing permanent!

Benefits of no epidural:

• Reduced risks of above complications

• More mobility, you will be up and moving right after even though you just pushed out a baby!

• I believe less risk of laceration because you don't just blow your baby out because you can feel it and are a little more cautious!

• Babies are more alert right after birth and can help with early nursing.

Risks of no epidural:

you feel everything and it freakin' hurts! That’s not really a risk but it is real.

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Tips to having an unmedicated birth:

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1. Try to mentally prepare.

I know this is hard because you don't know exactly what day you will go into labor unless you are induced right, but most of the time your doctor can kind of give you an idea based on your symptoms and exam. Basically, I think what helped me is going into labor the first time I didn't have a plan that I wanted to follow, I basically was open to whatever had to happen to ultimately get the outcome of a healthy mom and healthy baby. Of course with my first I didn't know how it was going to feel or if I could handle the pain, but I basically told myself, your body is going to go through something that mujeres have been doing for thousands of years and it will be difficult, but I continued to build myself up in those last couple weeks before my delivery. I knew I was strong physically so the mental strength came with my mental preparation. Honestly, the mental strength ends up being more important during the "transition period" when you are almost going to get ready to deliver and your cervix usually goes from 8 to 10 centimeters and you are ready to push soon after. If you believe you can do it, you really can. The mind is a powerful thing!

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2. Focus on an image.

I didn't really learn this from anyone but I thought hey if I can focus on something when the pain gets rough maybe that will help me. I ended up using a small ultrasound picture of Leonel during his labor and with my last labor for Max I had a picture of the boys at the beach and Max's ultrasound picture. Knowing that you are going through the process to meet your beautiful baby and you can visualize that face from the picture to imagining how our baby will look when you are done, that can really help you to get through those crazy contractions and pressure sensation. Of course, you can use any picture that you love, just try something that will keep your mind focused and know what's coming soon which of course is exciting.

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3. Positioning.

This one is very important because with an unmedicated birth you have the benefit to move freely especially if your hospital has a wireless monitoring system and you can find what positions ease the pain. I find most patients love the medicine ball you can sit on or standing and rocking from side to side but for me, it was the toilet. ;0) Yes the toilet. I sat on the toilet until my transition phase and listened to my favorite music and moved to the bed when I knew it was time. Being in the position gave me the support I needed to get through the pain and helped to get my baby into the position to put pressure on my cervix and allowed my labor to progress I believe more quickly.

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4. Last but definitely not least, listen to your body.

our body was made for this and it will tell you what you can and can’t tolerate. It will tell you when you are getting close to delivery and it will tell you when it is time to push! I promise you. This is an amazing process in the evolution of life and your body was made for this! #mindovermatter

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So mujeres are you on team Epidural or team No epidural? I’d love to hear your story in the comments!!!

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