10 Dumb Reasons to Request an Epidural

and 1 Smart One

Being an educator who believes very much in freedom of choice, my goal is to offer information (not advice) about pain medication and other aspects of labor, and then to allow mothers to make their own decisions. I have nothing against epidurals, but I want women to choose them because they want them, and not because they feel they "have to." With that in mind, here are a few reasons you may have heard for requesting an epidural.

1.        Your friends (and total strangers) tell you to. Maybe your friends have told you how happy they were with the epidural. This is important information, which you should take into account when planning your own birth. However, your personality, philosophy, medical condition, and labor may be very different from theirs; no one else can really know what's best for you.

2.       You want your muscles to relax so that labor will go faster. This is a great theory. The only problem is that all the evidence we have indicates that epidurals either don't affect the length of labor or they slow it down.

3.       Your doctor or nurse recommends it.  Many medical professionals recommend epidurals for labor because they would choose an epidural for their own (or spouse's) labors. Of course, if your doctor gives you a medical reason to have an epidural, that would be a different matter, but if the recommendation is based on a personal opinion, you may reserve the right to disagree.

4.       You don't want your partner to have to see you in pain. Some partners find it very difficult to see the woman they love in pain (which seems perfectly reasonable). If you're worried about this, you might consider finding a friend, relative, or professional doula to help you cope with your labor, and allow your partner to relax and enjoy the experience.

5.       You're afraid you'll miss the "window of opportunity".  Everyone has heard a story of a woman who decided she wanted an epidural, only to be told it was "too late." This is a scary thought! It is true that sometimes labor is going so fast at the end that an epidural won't have time to take effect. The trouble is this rapid acceleration phase is unpredictable, and doesn't start at any set dilation. Ask your doctor if there is any time when it would be too late to get an epidural; few doctors would withhold an epidural even during the pushing stage if you really need it.

6.       You're worried that the pain will get worse later. Since you never know when the pain has peaked in any given labor, no one can tell you whether the pain is likely to get worse later on or how long labor is going to last. Since no one can tell you what to expect, you have only the present to go on. As long as you can handle the current level of pain, there's no way of knowing whether you will want an epidural later or not. In labor, the only time is right now.

7.       You're afraid you won't have enough energy to push. Most women feel very tired during the active phase of labor. The release of oxytocin (the hormone that stimulates contractions) makes women feel exhausted, and sometimes they doubt their own stamina. Women often feel they are "running on empty," and choose to have an epidural so they can rest and have the energy to push later on. However, the physiologic sleepiness of active labor is replaced by a burst of stress hormones at the onset of the pushing stage, which gives women a new lease on life and the ability to push - without an epidural.

8.       You don't want the baby to be stressed. We don't really know whether babies find labor painful or not, since we can't ask them. Physiologically, being squeezed is much less painful than being stretched, so if it does hurt, probably not as much as for the mother. While small amounts of medication do cross the placenta from the epidural, apparently not enough to give the baby pain relief anyway. In addition, babies need some stress hormones to help them adapt to life outside the uterus.

9.       You don't want to have a cesarean. There is mixed evidence on whether epidural anesthesia increases the chances of cesarean or not, but there is no evidence that epidurals reduce the chances of cesarean. Although the jury is still out, probably the best way to reduce your chances of a cesarean are to wait until you are 5 cm dilated and the baby is halfway through the pelvis (O station) before getting any medication.

10.    Recovery will be easier. This seems logical, until you remember that your uterus, which is what does the work of labor, has to do the same amount of work regardless of the amount of pain you feel. While pain itself is tiring, so are the effects of anesthesia. When you take into account the fact that epidurals may make labor last longer, it makes sense that women who have epidurals usually take a little longer to get back on their feet than women who don't use medication at all.

It may sound like there isn't a good reason to have an epidural. Au contraire, amigas! Here is one very good reason to get an epidural:

1.        You don't want to feel the pain of labor. This is all the reason you need. Whether you start out knowing that you don't want to feel all of labor's pain, or you decide sometime during labor that you have felt enough pain (thank you very much), epidural anesthesia offers the best pain relief. You don't need any special reason (such as a long labor, back labor, or induced labor) to "deserve" pain relief; if you decide you want it, you have every right to choose it.

Whether or not you plan to use an epidural for pain relief during labor, this class will help you discover your options, understand the practical details about epidurals, and make an intelligent and appropriate decision during labor.

Copywrite 1999 Kelli Way

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