With less than two months to go before my due date, I've read a lot about my pain-management options, including the epidural. Before diving into the information out there, my general opinion went something like this: I wouldn't have a major surgery without anesthesia, so why would I shun this modern medical marvel for labor? Still, I wanted to make sure I understood the pros and cons of getting an epidural. So I did some research and spoke to real moms about their experiences, recounted below.
First, I needed to know how it works. An epidural is local pain relief that is administered by an anesthesiologist during the first stage of labor (while your cervix is dilating). The doctor puts a needle in your back in the space surrounding your spine and then inserts a catheter (a thin tube) to deliver the drugs. Once it kicks in, the lower half of your body will be numb to pain. Women in labor can typically self-administer the drug (up to a max) during labor, depending on how much they want.
The list of cons looks longer than the pros, but the major benefit of an epidural — very effective pain relief — should not be discounted.
To understand the benefits and potential downsides, I turned to Emily Oster's book Expecting Better [1], which I've found to be a rational resource that cuts through all the pregnancy noise. As a professor (in economics), Oster takes an academic research approach to pregnancy questions and evaluates various studies on different topics, including pain drugs. Based on what I read in her book, as well as my the information I got in my pre-child-birthing class and from my doctor, here's how I would sum up the pros and cons of an epidural:
Pros:
- Very effective pain relief.
- It does not impact a baby's APGAR score [2], fetal distress, the chances that a baby will spend time in the NICU, or the ability to breastfeed.
- No increase in overall C-section rates, according to most studies.
Cons:
- Can lengthen labor, especially the "pushing" phase.
- Greater use of pitocin [3] in labor to speed up stalled contractions.
- More likely to use instruments like forceps or vacuums [4] to assist with labor.
- Greater chance of "tearing" or needing an episiotomy [5].
- Could cause mother's blood pressure to drop suddenly, which may require medication or oxygen.
- Can't be mobile during labor, and it's more difficult to walk after labor.
- Increases chance of needing a catheter to pee.
- Increases odds that the mother has a fever during labor. Because doctors can't tell if the fever is due to an infection, they will likely treat the baby with antibiotics, which may not be necessary.
- Small chance of painful headache that lasts a few days, and an extremely small risk of a dangerous infection or bleeding near the spinal canal.
The list of cons looks longer than the pros, but the major benefit of an epidural — very effective pain relief — should not be discounted. And it doesn't appear that the drugs come with any major side effects for the baby. Sill, I wasn't content with a simple list of scientific pros and cons. I decided to talk to more women who chose to have epidurals (and two who didn't), turning to my fellow POPSUGAR editors for their advice. One theme emerged: no matter what I decide, I shouldn't put too much pressure on myself to have the "perfect" birth. Here's what they told me about their experiences:
Mom 1: Pain Relief Helped Her Feel Present During Birth
"I always assumed I would go the epidural route, but when I discovered that my red blood cell count was abnormally low, my gyno told me that I might be too high risk for one if my cell count kept dropping. I began reading more about natural labor and exploring alternative methods for staying relaxed and focused during labor, which are helpful even when you have an epidural.
"I rested while my labor progressed and just tried to soak everything in. Five hours later, I was pushing and meeting my son. It was a beautiful and peaceful experience."
When the blood results showed that I could have an epidural safely, I remember feeling a huge sense of relief. It was taking everything I had in me to focus on getting through each contraction, but the epidural changed all of that instantly. My body immediately relaxed and my mind followed suit. The lights were dimmed, battery-operated candles were on, my playlist was going, and my aromatherapy diffuser was filling the room with the scent of lavender essential oil. I had my mom and sister telling stories and chatting on the sofa with coffee in their hands and my husband by my side. I had heard that epidurals can sometimes slow down labor but that didn't happen for me. I rested while my labor progressed and just tried to soak everything in. Five hours later, I was pushing and meeting my son. It was a beautiful and peaceful experience.
I have zero regrets about having an epidural and would definitely do it again. I still felt incredibly connected — both physically and mentally — throughout labor was so grateful to have the opportunity to rest and be present without going through hours of pain and physical exhaustion. In my experience, having an epidural didn't take anything away from the experience that I wanted to miss, but it gave me so much."
Mom 2: Still Felt the Effects of the Epidural 12 Hours Later
"I always felt open minded that I would most likely get the epidural. I wanted to ride it out and see how long I could go without it, but I always mentally gave myself an out. Once I got it, the pain vanished. I was comfortable, relaxed, and able to joke around with my husband and the medical team through contractions. The cons were that you aren't allowed to stand up. Since walking around was what kept labor moving for me, things really slowed down once I got the epidural. Also, because you can't feel anything, I didn't know that I had to go to the bathroom. I had to have a catheter more than 12 hours after giving birth, simply because I still couldn't feel my bladder.
"I had to have a catheter more than 12 hours after giving birth, simply because I still couldn't feel my bladder."
The best advice that I got was from my own doctor. I asked if I should have a birth plan including epidural timing and she said, 'The only birth plan you should have is to have a safe delivery and a healthy baby at the end. If you try to plan more than that, you're going to be disappointed.' Giving myself this freedom and flexibility really took a lot of stress out of labor and delivery. With no plan aside from a safe and healthy outcome, I could talk to the doctors, my partner, and make decisions as needed without anything holding me back."
Mom 3: Epidural Made Emergency C-Section Easier
"I was always planning on getting an epidural. I figured there was no reason to suffer if I didn't have to! With my first, labor was so much more intense than I could have ever anticipated and I would have gotten an epidural much sooner if they would have let me. Once I finally did get it, the relief was immediate. It was truly amazing and allowed me to rest and relax after nearly 20 hours of contractions.
Luckily I had one because I ended up with an emergency C-section, so they were able to quickly perform the surgery without putting me under general anesthesia.
In terms of people deciding whether to get one, I think it's totally personal. Maybe you don't plan on it, but then you are in the middle of crazy contractions and you feel like you need it; there's no reason not to be flexible. Maybe you know you want one and you are shocked when you're already nine centimeters and decide to go ahead without it. There's no reason to be rigid with the decision — or any part of your birth plan, for that matter, since you can't predict how things will go or how you'll feel at the time."
Mom 4: Decided Against Epidural and Says Natural Birth Was Hardest Thing She's Ever Done
"While I knew that there were many circumstances outside of my control, I did everything I could to push the circumstances in the direction of a vaginal, unmedicated birth. I did prenatal yoga, hired a doula, wrote a birth plan to inform hospital staff of my wishes to have as few interventions as possible, and declined an epidural. My avoidance of epidurals was largely because research shows that they tend to slow down labor and lead to other interventions.
Despite my intense birth preparation, I tried to keep my expectations in check. If an emergency cesarean proved necessary or an epidural became the right decision for me, I didn't want to come home from the hospital feeling depressed or defeated. A healthy baby and mother were the ultimate goal, so when the time came, I kept my focus on just getting through each individual contraction and seeing how far I could go unmedicated. The longer I labored — 26 hours of relentless contractions in total — the better I got at mentally managing the pain and the less necessary an epidural seemed until at long last I was pushing and delivering my son.
"The benefits to being epidural free were being able to move around while laboring."
The benefits to being epidural free were being able to move around while laboring. I alternated walking the halls of the hospital with soaking in a hot tub. I was able to push from more natural-feeling positions than on my back. Immediately after delivering the placenta, I got out of bed to use the restroom and I was walking to the recovery room a couple hours after that. The downside is that while laboring for more than a day, I did not get a single break. Not a second to close to my eyes, not a moment for my body to let go. Laboring unmedicated took every ounce of physical and mental fortitude I had. When my son was finally born, I was more excited to finally go to sleep than to hold him. It was the deepest level of exhaustion I've ever felt. I got the birth I wanted on paper, but, honestly, it isn't a beautiful or peaceful memory. It was the hardest, most intense thing I've ever done.
It has taken me two years to process my son's birth, and I'm now expecting my second child and ready to try unmedicated birth again. Learning from my first experience, however, I'm making a concerted effort to keep the mood throughout labor as light and joyful. I'm working with a different doula, who is known for helping moms laugh through contractions as finding that relaxing release in between them. She has told me that second births are known as the 'healing birth,' and I'm hoping that is true.
While I know part of my son's natural birth was luck (there was no medical emergency requiring intervention), there is a certain pride in knowing that I was able to stick with such a long birth unmedicated to the end. But whether or not that outweighs the experience of having a calm and painless birth is personal preference. I would advise expecting moms to educate yourselves on labor, look at all the data, weigh what about the birth experience is most important to you, and then act from there. There's no right or wrong decision when it comes to getting an epidural. The important thing is to do what's best for you, not your doctor or your mom or your spouse. You are your own best advocate, but you have to exercise that power. Figure out what you want and make sure everyone around you is on board."
Mom 5: Had One Birth With Epidural and One Without
"I have given birth twice and had one delivery with an epidural and one without. I wanted to make it through the first without one, but I had back labor (where I only felt the contraction in my spine) and then just about every intervention one can have aside from a C-section. I went into the second delivery more confident that I could go without because I could actually feel the contractions in my uterus, meaning I could tell the contractions were working. During my first labor, I never felt that.
"With the epidural, since your legs are numb, you aren't supposed to stand or squat, or even walk around, so you feel a little trapped in the bed."
When I got the epidural during my first delivery, I had had my water broken and was really suffering. My contractions were beyond painful, but not helping me dilate. My labor essentially stalled. My husband and doula encouraged me to get the epidural, which worked. I slept and, after two or three hours, was ready to push.
The cons with epidural, which I feel no one really talks about, is that you have to get a catheter. Which meant I felt I was leaking urine for days after the first delivery. With the second birth, this was not an issue at all. Do what you need to do and don't judge yourself for getting an epidural, but I do think it is worth it to try to labor without one. The recovery is quicker and you have many more options for pushing. With the epidural, since your legs are numb, you aren't supposed to stand or squat, or even walk around, so you feel a little trapped in the bed.
The recovery and delivery was much quicker without the epidural, but it was also my second delivery and those seem to go more quickly and the recovery easier. With the epidural, the nurses would tell me when to push based on the monitor. Without the epidural, I was shocked that I had to actually coordinate pushing with intense contractions — I remember asking, 'Wait, what?' to much unintentional comic effect. The other cool thing is I could feel the baby working with me in labor. She broke my water and I could feel it, which was amazing."
Mom 6: Waited Until 7 Centimeters and Had a Fast Recovery
"I went in with this idea: if the birth is moving along quickly, try to go without the epidural. If it takes a long time, try to hold out as long as possible. I didn't get the epidural until I was about seven centimeters.
People told me that you recover faster and birth can happen faster without the epidural, and those were really the only reasons I thought to try it out without it. I didn't feel like there was a ton of info out there on how epidurals affect babies — and if there was, it didn't seem strong enough of an argument — so I didn't think about that too much.
Even with the epidural, I recovered pretty quickly, and my delivery wasn't unusually long. Once I had the epidural, I didn't feel a thing until the pressure of the baby coming out later, so it feels like a bit of a breeze after that. For my next child, I would like to try it sans epidural just to see for myself."
Mom 7: Epidural Helped Her Cope With Complications
"Based on friends' experiences, I understood that you can't plan for everything and that unexpected situations come up all the time. My basic plan was to go without an epidural, see how things went, and ask for one if it felt necessary. Honestly, there's enough pressure going into labor as is, and I wanted to allow myself the freedom to make whatever decision felt right in the moment.
I made it to eight centimeters without an epidural, but things started to slow down and I'd been awake for more than 24 hours, so I decided to get an epidural to rest up for the final push. That turned out to be a very, very good choice, because several complications arose and a quick episiotomy and forceps were needed to deliver my son.
Don't be too hard on yourself about going one way or the other. Staying open helped me make a decision that felt right based on the birthing circumstances, which you really can't predict until you're in the moment."
Overall, these women were happy with their choices, making me feel empowered to take a similar approach when it's my turn to deliver: I'll go in with an open yet informed mind and make a decision when I actually have a sense of what it feels like to go into labor.