Is labor pain falling out of favor as a rite of passage? It just may be, based on reports from a recent anesthesiology conference that the number of epidurals administered annually is on a steady climb. In fact, from 1981 to 1997, the percentage of women receiving them at large hospitals more than tripled, from 22 percent to 66 percent. At Allegheny General Hospital, 90 percent of the women delivering there receive epidurals.
It could be the pharmacologic improvements during the last few years, making epidurals safer than ever. Previously, women worried an epidural might make them unable to move during labor. Today, smaller amounts of medication yield more effective pain relief with fewer side effects, so women are more apt to consider these options.
Epidurals have long been the subject of numerous research studies to determine safety, efficacy and potential complications. In late 1998, the Journal of the American Medical Association published an analysis of 10 clinical trials that found epidurals provide more effective pain relief while having less effect on newborns' health than narcotic injections. Despite these findings and recent advancements, midwives stress that the normal event of childbirth can truly empower women.
Midwives tend to be very supportive of getting women through the birth process, and more than 50 percent of their patients deliver without medication. Assuming women must have epidurals implies that they can't tolerate the pain associated with birth.
They're not against using medications; in fact, they encourage it in certain cases. Their focus is helping women trust and believe that they are capable of bringing forth their babies with emotional and physical support, and encouragement. If more extensive pain management is needed, they want women to make informed choices based on good information about the risks and benefits of the types available.
Although significantly reduced, risks related to epidurals still exist and may include: a drop in blood pressure, causing nausea, vomiting, dizziness and fetal distress; allergic reactions; difficulty emptying the bladder; and spinal headaches. In the past, epidurals were linked to increased Caesarean deliveries; however, some recent studies seem to refute those beliefs. Many researchers have studied the link between epidurals and C-sections, yet no one has proven that it puts women at increased risk. Instead, obstetrical providers generally believe that complicated deliveries ending in C-sections are among the most painful, requiring more significant pain management intervention.
It's best to not have too many preconceived ideas during pregnancy and to keep an open mind about pain control. Pain management options are addressed at childbirth classes, regular prenatal office visits and during an anesthesia consultation once you are in labor. But until you're actually experiencing it, you can't always know how you'll react. Labor pain can be managed without medications if you are mentally prepared. However, it's most important to have realistic expectations regarding childbirth and then to be comfortable with the decision you've made.
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Last Updated: September 24, 2009