Monday, September 20, 2010

The Truth About Epidurals

By Carol Gray
posted with author's permission
read more from Gray at: CarolGray.com



First a word or two about birth physiology: Labor is almost universally uncomfortable for mothers, and often painful for babies. One of the ways we cope with pain is to produce beta-endorphin. Beta-endorphin is an opiate-like brain chemical - the same one responsible for the so-called "runner’s high." It reduces pain and increases good feelings.

In a typical labor, pain increases over time. As the pain increases, the production of beta-endorphin also increases. Mothers and babies both produce beta-endorphin. The beta-endorphin produced by mother also passes on to baby through the placenta.

At the moment of birth, the pain of labor suddenly and dramatically decreases for the mother. Mothers and babies are flooded with endorphins that, with little to no pain, cause euphoria.

We know that endorphins create a state of dependence. After a medically undisturbed birth mom and baby will repeatedly seek to recreate that initial high of birth euphoria with close skin to skin contact. We know that babies need this contact to survive and develop normally.

Sometimes babies are hurt in the birth process. It’s obvious when they come out with swelling, bruises or broken bones. Sometimes they appear frightened or shocked. In that moment they are supposed to rely on an extra boost of endorphins from their mothers.

The Truth: Mothers who have epidurals typically experience little to no pain in their labors. If mothers experience little to no pain, they produce little to no beta-endorphin. When mothers produce little to no beta-endorphin, their babies have more painful births. This pain could be extreme. This pain can interfere with bonding. There is no state of euphoria for mom or baby. We have no idea what the lifetime effects of this could be.


Carol Gray, Midwife, LMT, practices and teaches Craniosacral Therapy for infants and mamas. She also attends home births in Portland, Oregon.


For information on the subject of infant pain in labor and birth, and gentle birth, see:

Birth As We Know It [video]

Epidurals: Risks and Concerns for Mother & Baby


Primal Health

Birth and Breastfeeding

The Scientification of Love


Gentle Birth, Gentle Mothering

Gentle Birth Choices

Birth Reborn

Infant Pain Impacts Adult Sensitivity [article]

Birth From Baby's Perspective [article]


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40 comments:

  1. Interesting piece...convincing to me, but I am already very anti-epidural! But, to play devil's advocate: I was under the impression that babies were affected by epidurals as well (sluggishness, etc) - do babies not get *any* of the pain-relief aspects of the epidural in addition to the yicky side effects? That may indeed be the case, but I can imagine moms who've gotten (or plan to get) epidurals raising this question.

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  2. What if you have an epidural but still have excruciating pain?

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  3. I appreciate the "spirit" of this post, but am frustrated by the reification of the notion of birth as painful. Some argue (see, Dick-Read) that birth is not painful by default, but that pain comes from fear (a vicious cycle). When we look to other less-industrialized cultures we find women their birthing without remark of pain, but rather discussing the hard work of the process.

    Again, I do NOT want to criticize the post or the intention of the post (well said), just wanted to throw out a thought about the "birth=pain" issue for consideration.

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  4. Had I known (in the guiltless way). I wish I was more proactive and understanding they way birth worked.

    It's so funny that I looked into everything else except the birth... I don't know why?

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  5. Hmm, I had epidurals with all my babies because I am extremely sensitive to pain and can not efficiently dilate without help relaxing and I could not imagine a closer bond with my children.
    I personally think for me that all my bonding occurs after they are born; taking care of them day in and day out, breastfeeding, co-sleeping, snuggling, kissing owies, being there for them, reading to them, not causing trauma after birth for my boys, etc.
    As for side effects for baby, the epidural is place in your spinal column and that does not cause a systemic effect. IV or IM would make a sleepy baby depending on half life (time the drug stays in your system), but all my babies apgars at 1 min and 5 min were 8 or above.

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    Replies
    1. I could have written your post, word for word. This was, and has been, my experience, three times over.

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  6. A massage therapist once told me that she could tell without asking, 6 weeks after the birth, if a baby's mother had an epidural, just from his muscle tone.

    Of course the medication from the epidural reaches the baby. The babies act stupified at the breast, often coming the the breast, latching on, and then waiting for something to happen, a something called suckling which they apparently can't remember to start doing.

    I think of it like having a few drinks too many, and trying to put the key in your front door to unlock it; it's just awkward, and often unsuccessful, and frustrating, and you may need help.

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  7. Being a first-time mom and never giving birth before, I knew that I wanted a completely natural birth but was told by my peers that I would give in as soon as the labor pains started. I was pretty determined to not have any interventions but I still decided to give birth in a hospital (luckily I had a more 'holistic' doctor). I managed labor better than I ever expected and without any type of intervention. When the doctor placed my daughter on my chest, she had this calm, peacefulness about her that was telling me, "Thank you mommy for birthing me without the drugs". She layed with me, we nursed and enjoyed each other. As a woman, we are designed to give birth. We can handle the pain, the end result is a miracle and the pain is a faded memory.

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  8. Mandy, I think you bring up a good point. Perhaps the "pain" isn't experienced as such when fear is absent because of the beta-endorphins?

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  9. I cannot scientifically prove this either, but after seeing many epidural born babies and many more non-epidural born babies, and understanding both hormonal and birth mechanics, I would have to hypothesis that epidurals may make the pain go away for the mothers but also make the birth more painful for the babies...

    The natural endorphins that the mothers' body produces in the feedback loop of labor stop being produced with epidurals. These babies then are not being bathed with those natural hormones, thus they are not receiving natural painkillers.

    The epidural anesthesia does not effect babies in the same way it effects the mothers....

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  10. I have to agree with Mandy in regards to birth being "painful"

    Personally I had both of my children naturally, and I'm planning a homebirth for my third due in just a couple months. I would not consider either of my births painful. The worst part was the contractions which were not so painful when my amazing husband kept me calm and focused. I did definitely experience the adrenaline and endorphine high that comes from birthing naturally though, and it was one of the best feelings I've ever had. Even after a long sleepless night of laboring/birthing my daughter, I had no desire to sleep afterwards, but instead chose to spend that time bonding with her. It's a wonderful experience that , though may not be everyone's choice, I would recommend to all expecting mothers to at least try for.

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  11. if strengthening the instinctual mother child bonds is at all important, and so many things in 'modern medicine', when it comes to reproductive health, causes the bond to weaken, wouldn't reducing those things that interfere with it be important? so you need pain mediation, fine, knowing what else to do/not do is important. there's a long list of things that supposedly improve the bond, if the only important bonding exercises are hours, days, weeks even, after birth, there would be no evidence that bonds are affected by things done during delivery.

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  12. Stephanie,

    It is true that the epidural medications reach the baby and affect the baby, but they likely do not provide the level of relief that the endorphins do simply because they are diluted in the whole blood stream. There is a reason that the epidural meds are placed right in the woman's spinal spaces, and not injected via IV. It is because less medication can be used to get the same pain relief if it is placed at the site where it needs to act, rather than diluted in the whole body.

    It is actually for that reason that I had decided that *if* I needed pain meds in labor, I wanted an epidural (which contains narcotics) rather than IV narcotics...I didn't want the large volume of narcotics in my system.

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  13. I would disagree w/ Mandy about labor being painful as a result of fear. I had both my babies at home, w/o any pain medication at all. I was fully educated on what to expect and how to deal w/ labor. W/ my first I practiced Bradley w/ my second Hypnobirthing. Both births were beyond painful-so much so that the second one I almost passed out from pain. That is w/ active practicing of both my birthing techniques. There probably isn't anything that is going to make my labors not painful.

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  14. Helen - I had a midwife tell me she could tell even a year later which babies were born with an epidural or c/s vs an unmedicated birth. Very interesting!

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  15. To anonymous that posted at 12:23pm on 9/22/10: i'm about to birth my first child and while i'm going to try to refrain from any type of drug intervention, i totally understand what you're saying. Personally - i've slipped into a minor state of shock many times while having menstrual cramps. In fact, the first time i had menstrual cramps i fainted and went through a series of medical testing which proved there was nothing wrong with my heart or brain...so the result was i was in immense pain and couldn't handle it. that being said, i understand that MOST women are made for birth and CAN handle it without any type of drug intervention. but SOME women can't. a woman who goes into shock or passes out during the birthing process is not going to be able to cooperate and participate in the delivery very well. She may end up needing surgical intervention due to this...which is worse for mother and baby? surgical intervention due to going into shock and being unable to complete the delivery process or an epidural/narcotic pain killer.... which will prevent bonding more? i consider myself a pretty intelligent woman, and i'm thinking a mother recovering from a surgery is going to have a harder time bonding with baby than if the baby is drugged for a little while and POSSIBLY felt more pain during the delivery than s/he might have without drug intervention...i'm just sayin.

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  16. I'm not sure I agree with the "no pain" comment on childbirth. I had no apprehensions about birth and looked forward to it. I had a hypnobirth and it was amazing and tranquil, but I still experienced pain (mostly after transition). I agree that if I was stressed the pain could have seemed much worse, but it was still there.

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  17. Alyssa -

    As an encouragement, just wanted to let you know that I've also experienced horrific pain (to the point of passing out several times) with periods over the course of my life (I am now 38). I've also birthed at home (in water). Labor (even my 36 hour labor) and birth were not close to being as painful as some of my periods.

    Interestingly, I've heard from two midwives, one OB, and several other women who have extremely difficult (painful) periods that their natural births at home (even the OB had a homebirth!) were no where close to being as painful as some of their menstrual contractions.

    Labor and birth flood the body with endorphins, and the birthing waves (as I like to call them) come gradually, and in amounts that can be dealt with - very much unlike the pounding of menstrual contractions that can happen in the absence of birth hormones.

    Now, if I was to attempt birth in a hospital, I would likely need to be knocked out... not sure I could deal with all the protocol, drama, ignorance, and treating-me-like-a-sick-person in the midst of being in laborland.

    But I just wanted to lend you another example (that I've heard repeatedly from others as well).

    Painful periods to not typically equate to painful birthing experiences.

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  18. I also object to equating birth with pain. I don't see how anyone can know what any individual woman's experience is going to be, so we should all tell our stories and allow the possibility that any given woman's birth will be completely different. For myself, I've had five natural births and I would much rather go through that discomfort, which I cannot say was painful, than break my arm again or have another migraine, which in my experience are excruciating. To say that birth is almost always painful is to set women up to expect and perhaps thus manifest something that might not have otherwise occurred.

    I do appreciate this informative article about the possible negative consequences of epidurals.

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  19. While I in general believe in drug-free births, I find it difficult to generalize. My first one was born three years ago, just with the help of my husband and my midwife, no medication or any other intervention. The birth was quick and wonderful.
    My second baby was born two days ago and I asked for an epidural after three hours of labour. Why? Because I have had a bad cold for over a week now and just had no energy whatsoever to let my body handle the pain. The delivery itself was just as painful as the first time so I did get my fair share of endorphins. My had an agpar of 9 at 1 min and started feeding right after latching on. Have I really given her a worse start into life than my son? Am I really a bad mother now? I am sure not because I think it is all about an informed decision and not about being totally anti-epidural.
    Sandra

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  20. It is possible to separate our experiences and personal emotions from research, science, and theory. We know how epidural drugs work. We know the effect they have on the adult body, and we know *some* about the way that these drugs impact the infant body. There will be other variables at play from birth to birth - but in general, epidurals carry with them many risks that the average mother is not fully informed on prior to making her birth plans. She is not supported with accurate and complete information on her choices before and during birth, and she is *often* told that epidurals "don't matter" -- in fact, in a society where pitocin is ubiquitous, epidurals are just as common to automatically follow. And this over-use (and general medicalization of birth) is not healthy or beneficial for mother, for baby, or for humanity in general. Just look at the rate of U.S. morbidity and mortality... look at our rate of detachment... Something is seriously wrong, and it likely starts at violent birth.

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  21. Epidural release form comic

    http://www.xtranormal.com/watch/7019631/

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  22. Barbara - thank you!

    The line, "I don't believe in attachment." how many times it seems I've heard this from parents in a variety of forms... And the ending, "Let's go buy some baby clothes..." while they brush off all that was just brought up, how common is this as well in our dis-attached, disillusioned society.

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  23. I had an epidural for my c-section... not what I envisioned for my first delivery. Had hoped to deliver my breech baby, but he went too far overdue and they wouldn't deliver him. I was fortunate, my midwife let us hold baby immediately after birth... and as soon as he was checked/weighed, he was brought back to me to nurse (w/in 30 mins)... that was no problem, and fortunately we did not have any issues. I do feel I missed out on the whole birthing process and look forward to my next one, which hopefully will be as natural as possible!

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  24. I think this is very interesting. It's true that we don't know the long-term consequences for babies, and even then there has to be a variety of variables that play into developmental problems.

    I am pretty fierce advocate for natural, unmedicated birth and I attempted a homebirth with my now 6mo old daughter. I had the most incredible, knowledgeable, and supportive midwife. Even with all the natural help I received, I had severe hyperemesis of labor, to the point where I was wretching and vomiting with every single contraction. It was excruciating and traumatizing. I'm also a doula, so I had a lot of experience with breathing techniques, visualization, and general knowledge about the birth experience. Anyway, I got so severely dehydrated that my labor stalled and I was getting very pale/sick/dizzy. We had to get to the hospital, where I received IV fluids, Zofran and Phenergan, but it didn't help. I kept vomiting, plus my contractions were getting more and more painful as I began to catch onto the fact that this was not a good situation (i.e. the adrenaline and fear was creating the more intense pain) The only thing that helped me was to get that blasted epidural.. After I got it, I napped for about 2 hours then Evelyn was born with about 45 mins of un-coached pushing. I actually reached down and birthed her myself! She nursed after about an hour, but I know that she was still feeling the effects of the epi. At 6 months, our pedi diagnosed her with "noodle legs" where she doesn't want to stand up. She has incredible head, neck, and back control, but she refuses to stand up. I'm wondering if that had anything to do with the epidural, but I have been told that there's no way to tell and that plenty of naturally birthed babies have noodle legs, too.

    So I *DO* have concerns that getting the epidural might have harmed my sweet baby girl. I think about it quite often. But what helps me feel better is knowing that in my situation, I would have died if my midwife hadn't suggested it. I was losing so much fluid and I was starting to re-herniate my esophagus (I had 8 months of severe hyperemesis with two bouts of esophageal herniation). I hear about other women who went through natural labors with mild to moderate vomiting but that wasn't me.

    Do you guys think that my situation is unique or could something else have been done? I've spoken with two other midwives and two OBs whom I trust and love, and they all said that with my hyperemesis history and then hyperemesis of labor, the epidural probably saved my life and possibly the baby's.

    I'm definitely not coming from a defensive place here! I am an advocate for natural birth and I feel it is the safest was for normal, healthy moms and babies.. I just keep wondering if it was the right choice for me.

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    Replies
    1. Have you taken your daughter to a chiropractor?

      Also, babies don't usually stand a 6 months either. Give her a chance to be ready to accomplish her milestones on her own! :)

      Delete
  25. (KJMatter- Thanks!!)

    Christine-I think and informed and empowered birth is the goal. I am glad that there are options for people to HAVE the tool of an epidural to use when needed. I am horrified that people think that having and epidural is the same thing as a natural birth. " The as long as the baby is out mentality."

    I applaud you for being a conscious, empowered mother- and educating yourself.

    In the future if you get pregnant, I suggest EFT for the hyperemesis as soon as you get pregnant. You might be able to avoid the dis- ease. ( My favorite is www.thriving now.com. Rick Wilkes. you can learn for free , or hire him as a coach.)

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  26. My daughter with whom I had the epidural had all kinds of problems at birth, all from being induced. (In my opinion) because everything was fine until she got the pitocin. Since I was numb I didnt get the good feelings (endorphins) and neither did she. The nurses and doctor took her from us at birth because of heart rhythm problems. So it was a double whammy for her and I both, no bonding, NICU and I had increased swelling from the pitocin and the epidural left me with a permanent sensitive spot on my back. :-( But she is healthy and in her terrible twos now!

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  27. >>>Mothers who have epidurals experience little to no pain in their labors. If mothers experience little to no pain, they produce little to no beta-endorphin. When mothers produce little to no beta-endorphin, their babies have more painful births. This pain could be extreme. This pain can interfere with bonding. We have no idea what the lifetime effects of this could be.<<< I did NOT have an epidural with any of my 3 kids and experienced no pain, some discomfort but nothing I would call pain. I did hypnobirthing. So in a case like this, do you think a woman SILL isn't producing the beta-endorphins? All of my babies were very responsive, calm and happy. Just curious your take on that in case others where wondering.

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  28. This is the missing piece of the puzzle for making a truly informed decision. Women must weigh ALL of the pros and cons of epidural anesthesia and explaining the altered physiology from the infants POV is one element that isn't addressed on hospital consent forms and so widely unknown.

    I'm not anti-epidural, but we have to understand that no intervention is without its consequences to mothers AND babies.

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  29. Why shouldn't birth be painful? A woman's cervix, which is normally firm and tightly closed, is being stretched to 4" across. An entire baby is moving through her vagina! These things hurt. What can't that just be okay? Birth is totally normal, and it can be totally normal for it to hurt. I trust in birth and I'm not afraid of pain. My births hurt like crazy... and I loved them and would do it again and again. Our culture has a big problem with pain. I say just deal with it, don't run and hide.

    As for medications in epidurals getting to babies, yes they do - through basic physiology. Epidural medication (which includes narcotics) is inserted into the space OUTSIDE the dura mater (the membrance surrounding the spinal cord and fluid), where over time it is absorbed into the woman's blood stream (that's how the body removes and moves substances), which means it gets to her baby over time. Anything within the dura mater is not absorbed into her blood stream, but that is not where epidural meds go. Hope that clarifies.

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  30. @anonymous

    My babies were 10 1/2 pounds with big heads so my cervix was stretching more like 6" across.

    I tried self hypno birthing my last baby and it completely took away the pain of the contractions, unless I became unfocused and let fear come in. The pain of the stretching of my cervix though was quite another story. My nurse sure looked strangly at me when I asked for an ice pack for my lower abdomen to ease the pain and swelling I was experencing at the bottom of my uterus after she was born.

    It helps so much to know your anatomy as well. I did not efface with any of my babies (4) until just before birth. I think that is because my uterus is almost folded in half and I carried all my babies way out in front. I think my body had to pull the baby in tward my spine, then push out through the birth cannal. It seems to be a two step process, and I had very long, very painful labors.

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  31. Just so Stephanie comment,

    I think babies are not afected by epidural because it is aplied in the mother's spine, not passing trough placenta.

    About this:


    The Truth: Mothers who have epidurals typically experience little to no pain in their labors.
    o q vale é q tipicamente é uma palavra q abrange opostos..


    My wife had 4 epidurals and had powerfull pain... so beta nao sei quantas was produced.. I think.

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  32. This makes perfect sense. And I agree with the person who objected to the use of the word painful to describe childbirth. I think some of us are able to relax to the point where we have the endorphins and euphoria well before the moment of birth. To me childbirth a joyous event, I experience little to no pain, and the idea of an epidural makes no sense at all. Why would you want to miss a moment of what is happening in your body? I love giving birth and have had six babies so far including twins.

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  33. Hm. I had an epidural, though I did not want one. I planned a waterbirth at a birth center. My water broke and we tried to induce labor naturally unsuccessfully for 36 hours. I tried every method... In my state, it is law that you must be induced in a hospital if your water has been broken for 24 hours without labor starting. My midwife gave me extra time. I was 5 cm 90% effaced when i went in to be induced. A foley bulb would no longer have been any good. I received Pitocin at 7:30 pm and after 6 hours of back breaking labor with absolutely no break in between contractions and screaming like crazy despite trying to use the hypnobirth techniques I had spent so much time learning and practicing, I still had not dilated past 5 cm. I was in incredible pain from the pitocin, and i got the epi. My son had an APGAR score of 9. However, he never latched. I have been pumping breastmilk for him since he was born since he literally never latched. I saw three lactation consultants and I tried hard with all kinds of techniques. I still try now, I am trying to bring him back to breast. I associate this issue with the epidural and the horrible breastfeeding "help" I received at the hospital. The epi helped me avoid a csection, I couldn't relax so I wasn't dilating. They were going to start pressuring me into a csection shortly. But it helped damage my breastfeeding relationship. I am very thankful that I respond well to the pump and have been able to EBF my son. My birth and nursing problems have made me so depressed.

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  34. I had a 14 hour labour with my first child, and other than Gas they wouldn't give me anything. She was stuck in my hip and rib cage and we couldn't get her to move. I had to have a csection after the 14 hours because I didn't dial ate at all. The pain wasn't pleasant but it was bearable. I am having a planned csection this time because I, like my mother, do not have bone openings large enough to have children naturally. While I would love to have a child naturally I question a lot of what the doctors give you in order to have a csection. I also had horrible breastfeeding help at my hospital and thankfully I got her to latch when we got home. I had a horrible break down in the hospital because the doctors and nurses made me feel horrible that my daughter was jaundis and was loosing weight. She was 9lbs 2.6 oz. I am only 5 feet tall, and I hate hospitals with a burning passion.

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  35. I am just curious, to those women who have to have a csections, is there anything other than the epidural that can be given? I understand how painful it is (been there done that), but are epidurals truly the safest best thing to give us women? I had labour for 14 hours with my daughter and after being induced because my own contractions wouldnt start or keep up, I had to have a csection. I never dilated, she was stuck in my hip and rib cage, and other than Gas I had nothing for the pain, she was also 9lbs 2.6 oz and I am just over 5 feet tall. It was painful, but it was bearable. I am tempted to try with my second one in a few months to try a natural birth again, but I am built exactly like my mother and do not have bone openings big enough to birth children naturally. I can relate to Veronica's post about breastfeeding, my daughter destroyed my nipples in the hospital, she was jaundis and all I got from the nurses that it was my fault. I hate hospitals with a burning passion and that did not help my mental state in the hospital. I also cannot take t3's because they make me loopy, so I truly do question a lot of what they give women in hospitals after the birth of their children and if they expect women to be ok?

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  36. I do not agree with this at all. I think that there is a hierarchy that has developed in the birthing community that natural birth is somehow better and that women that chose formula or pain relief are looked down on. How is this useful in supporting women? This extreme naturalist thinking is conservative at best! I admit, I thought that way after I took Bradley birth classes and thought that the only way was natural birth. While I believe that epidurals and pitocin are too freely given, and that natural birth is not respected in many hospitals, I think that epidurals can give a truly euphoric, healing experience. I love the book "Birthing From Within". It's ideas are not extreme black and white thinking. The book talks about epidurals as "compassionate medicine". That is exactly my experience with the epidural I received. My first birth was over 30 hours, stalled in transition for hours, pushing for two.My baby inhaled meconium and needed to be taken immediately to be treated by the NICU nurses. The long, painful birth left me traumatized to the point where I did not want to hold my baby right away. I did not feel euphoria! I thought I would never want to give birth again; but such is nature to forget pain. My second birth took lots of emotional preparation, including some therapy with EMDR. My labor was 7 hours, but most again, was in transition. I had a moment of surrender thinking, "Maybe all these natural birth extremists don't see the whole picture! There are shades of grey! Not all epidural births are bad!!!" I received the epidural in the loving care of nurse midwives. She even said, "You made the right choice." The pain relief allowed my body to relax and my cervix to finally get over 9 1/2 centimeters. I was present and able to look lovingly in my mother and husband's eyes as I pushed the baby out. I was euphoric for days! My baby latched on immediately and was completely alert. It was the most healing, beautiful experience. Thank god there is a choice to receive pain relief.

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    Replies
    1. I'd agree that there are times and places when an epidural may (*may* because they do not always work as expected) be beneficial to mom. However, they are rarely ever beneficial to baby, and there are two lives at play. Should a woman choose drugs fully informed of what she is asking for, and the possible implications both on her and her baby, that is one thing - but the way we misinform and keep women blinded to the truths about all aspects of drugs is quite the disservice. It is also good to note that there are many factors that go into gentle birth -- so merely being in a hospital in the first place sets a woman up for a less than positive experience (increased management of her labor, which increases pain more often than not) and this in turn can increase the domino effect of a 'need' for drugs.

      But we should all be able to own our own births and either feel positively about them, or able to work through the trauma that has come as a result of them - so if you feel it was best in your given circumstances - more power to you! :)

      Delete
  37. Pain in labor could be contributed by diet and excercise (or the lack there of) during pregnancy, don't ya'll think. I know when I'm getting adequate amounts of calcium magnesium, eating adequate amounts of organic vegetables and exercisinregularly menstrual cramps are not an issue. Pain in labor can be different for so many physiological reasons: fetal presentation, mother's labor positions and freedom to move around, pelvic malallignments from accidents. The biggest problem with epidurals is that it renders the mother bedbound and disconnects her from the important messages the nerves of her pelvic floor are sending her to guide her into positions in which will assist the descent and birth of her baby. The typical bedbound positions multiply the challenge of having a vaginal birth by narrowing the pelvis as the sacrum is pushed upward and into the pelvis and the baby is forced to exit in an upwards direction, against gravity.

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