Report cites increasing use of epidurals during labor - HealthLINK (Women)

Labor and birth, a very individualized experience

My patients often ask me about pain control early in their course of prenatal visits. My approach is to discuss all the options a woman has. Since there is no way to predict what kind of labor any particular woman is likely to have, decisions need to be made as the woman is experiencing her labor.

"…decisions need to be made as the woman is experiencing her labor."

Some women have very efficient labors. They push well and deliver their babies within a few hours. They may do well with a variety of supportive techniques we’ve found to be helpful such as massage, showers, birthing balls and intradermal injections of saline to help back pain. Other women have prolonged, painful, exhausting labors. They may choose to have pain medication. Epidurals are currently the most frequently administered form of pain relief. It is a very individual decision.

Epidurals not what they used to be
In the 25 years I’ve been delivering babies, I have witnessed an increase in the number of patients requesting epidurals. Between 50 and 60 percent of my patients have epidurals. What’s important to note is these pain medications bear little resemblance to those administered in previous decades.

Earlier, heavier doses of anesthesia used to control the pain of childbirth did cause potentially harmful side effects. The epidurals or motor blocks administered in the 1970s and 80s made it difficult for women to push. Labor slowed, and there were increased C-sections and forceps deliveries.

When I was in training in the early 1970s, the narcotics used in childbirth knocked women out. They were dehumanizing and made it impossible for women to participate in the birth process. The natural childbirth movement was largely a reaction to this situation. It was regarded as the alternative of choice and was favored by politically aware women who participated in the women’s movement in the late 60s.

But obstetric anesthesia has evolved, and there’s little similarity between those medications and what we’re using now. Many of the current critics of epidurals are using data from the 1960s and 1970s as the basis for their objections. Anesthesiologists are now providing very dilute formulations of drugs, and many women are able to move about during labor. They are able to push effectively; and when I look at the data from my patients, I see no increase in C-sections or forceps deliveries. My experience has been both obstetricians and anesthesiologists share the same goal: help healthy moms deliver healthy babies.

"Strong one-on-one support with continual eye contact and physical contact is very helpful."

Role of birth partners
One factor we’ve found is very helpful to women giving birth is the presence of a strong labor support partner. That person may be a spouse, a nurse, sister or friend. Strong one-on-one support with continual eye contact and physical contact is very helpful.

In the early 1970s, Dr. Strong, who practiced at the National Maternity Hospital in Dublin, reported very low C-section rates with what he called, "the active management of labor." He used a drug called pitocin to stimulate labor and guaranteed his patients delivery within a reasonable number of hours. He spoke about his technique in the U.S., and several hospitals tried using his method, but they were not able to reproduce his results. In addition to pitocin, Strong’s patients were paired with sisters who were labor support specialists, trained in very effective labor management techniques. These women would partner with patients and stay with them through delivery of the baby.

Clearly the labor support partners played an important role in his practice. In this country as well, research has demonstrated births attended by midwives often have a lower rates of C-sections. Techniques used by midwives and other labor support partners can be very helpful to laboring women, and many women may manage their labor with this support and do very well without pain medication.

Some women, however, may have had little rest for several days prior to going into labor. Because of many factors: the size of the pelvis, the position of the baby, they begin long, prolonged labor in an exhausted state. These women benefit enormously from epidurals.

"Women need to know what their options are."

Women need to know what their options are. My patients understand I will be with them and I’ll listen to what they tell me about how they are coping with their pain. We can begin an epidural as long as a woman is not about to deliver within an hour. It may take as long as an hour for the anesthesiologist to prepare her and deliver the medication.

After the epidural takes effect, many women are able to rest a bit in preparation for delivery. When the baby is born, these moms bond with their new babies as well as women who don’t receive any pain medication. In fact, they may bond better than women who are physically and emotionally exhausted from a prolonged, painful labor.

That instantaneous love between a mom and her newborn is a phenomenal sight to see. That bond and the health of the newborn are not compromised in any way by the epidural medications we're using now.

Dr. Simon is an attending gynecologist/obstetrician at Yale-New Haven Hospital and an assistant clinical professor in obstetrics and gynecology at the Yale School of Medicine. He is a partner of the County Obstetrics and Gynecology Group with offices in New Haven, Branford, Clinton and Wallingford.

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