The Truth About Epidurals: What You’re Not Always Told About Birth Choices

"Let us know what you think about this episode"

We explore epidurals in childbirth, examining what they are, their risks, and why unmedicated birth options deserve equal consideration in your birth plan.

• Epidurals are regional anesthesia using local anesthetics and opioids to block pain signals from the waist down
• Research shows epidurals can slow labor progression, especially during the pushing phase by up to 90 minutes
• Associated with higher likelihood of requiring vacuum extraction or forceps during delivery
• Can contribute to a cascade of interventions including Pitocin, continuous monitoring, and potentially C-section
• Side effects include maternal hypotension in 14-33% of cases, which can reduce blood flow to the placenta
• Rare complications include post-dural puncture headaches and nerve damage
• Can cause maternal fever (15% higher risk), potentially leading to unnecessary antibiotic treatment for baby
• May affect baby's alertness and rooting reflexes, creating challenges with early breastfeeding
• Despite risks, epidurals have benefits including pain relief, stress reduction, and making complicated labors manageable
• Create a "moment of crisis plan" to determine your first step when you need help during labor

If you found this episode helpful, please share it with a friend, leave a review, or subscribe for more evidence-based discussions on pregnancy and birth. Thank you for your support.

Links to research: 

Epidurals effect on second stage of labor -https://pubmed.ncbi.nlm.nih.gov/24499753/

Epidurals effects on vacuum or forceps use in birth -https://pmc.ncbi.nlm.nih.gov/articles/PMC6494646/

Reducted risk of cesarean delivery with discontinuation of pitocin in active labor   - https://www.ajog.org/article/S0002-9378(25)00161-9/fulltext

Epidurals and maternal fever -  https://www.ajog.org/article/S0002-9378(22)00480-X/fulltext

Epidurals and early breastfeeding difficulty -  https://www.ncbi.nlm.nih.gov/books/NBK501222/

Support the show

🎙 Thanks for Tuning into Tend & Befriend!

🌿 Learn More & Work With Me:
💻 Visit Website for my birth course, resources, and to book a session with me.

📲 Stay Connected:
📷 Instagram: @deborahthedoula
📘 Facebook: @deborahthedoula

💡 Loved this episode? Subscribe, leave a review, and share it with someone who needs it!

🔗 Find all links here: Our website

I hope to talk to you soon!!

Episode Transcript

Deborah (00:06):
Hey Mamas, you're listening to Tend and Befriend,
a podcast about women's mentaland physical health.
This is Debra.
I'm a mom of two, a labor andbirth coach and birth advocate,
a health professional, and todayI'm your host.
Let's dive into today's episode.
Your host, let's dive intotoday's episode.

(00:28):
Any information you hear orthat is suggested or recommended
on these episodes is notmedical advice.
Hello and welcome to Tend andBefriend, the podcast where we
explore evidence-based topics inpregnancy, birth and postpartum
with honesty and compassion.
I'm Debra, your doula, yourhost and childbirth educator,
and today we're discussing atopic that comes up in almost

(00:51):
every birth preferencesconversation Epidurals.
What are they, what are therisks and why is birthing
without an epidural often noteven discussed?
Let's unpack it all.
Let's begin by saying that anepidural is a form of regional
anesthesia commonly used duringlabor to block pain from the

(01:12):
waist down.
It's administered through acatheter placed in the epidural
space around your spinal cord,in the lower segment of your
lumbar spine.
The medications used in anepidural typically include a
combination of lidocaine orbupivacaine, which are local
anesthetics that block painsignals, and fentanyl or

(01:35):
sufentanil, which are opioidsthat enhance pain relief.
The goal of these combinationof drugs is to numb the lower
half of the body while allowingyou to remain awake and aware
during labor.
Epidurals can provide muchneeded relief for many birthing
people, but they're not withoutrisk and considerations.

(01:55):
While epidurals are widelyregarded safe, they do come with
potential risk and side effects.
So let's talk about those risks.
Research has shown thatepidurals can slow the
progression of labor, especiallyduring the second stage, which
is the pushing phase, and thishappens because epidurals reduce
the sensation and relaxation ofthe pelvic floor muscles, which

(02:17):
can then interfere with baby'sdescent.
A study published in Obstetricsand Gynecology in 2014 found
that epidurals increase theaverage length of the second
stage of labor, the pushingphase, by up to 90 minutes.
Wow, that's a long time Forsome birthing people.
This can increase the need foradditional interventions.

(02:39):
It's like a ball rollingdownhill, like Pitocin to
augment the contractions ballrolling downhill, like Pitocin
to augment the contractions.
Epidurals are also associatedwith a higher likelihood of
requiring vacuum extraction orforceps during delivery.
The Cochrane Database ofSystemic Reviews actually did a
really amazing report in 2018that said that women with
epidurals are more likely torequire instrumental delivery,

(03:02):
such as vacuum or forceps.
This increase basically and thestudy suggests this that it's
to do with the weakened pushingefforts due to the reduced
sensation and the coordinationof your abdominal muscles and
your pelvic floor during thatsecond stage, the pushing phase

(03:23):
of labor.
While modern research suggeststhat epidurals themselves don't
directly cause C-sections, theycan contribute to a cascade of
interventions that increase therisk.
For example, if labor slowssignificantly because of an
epidural and Pitocin doesn'thelp, then a cesarean section is

(03:44):
necessary.
In 2011, the American Journalof Obstetrics and Gynecology
highlighted that epiduralscontribute to longer labors,
which can lead to interventionslike Pitocin, which is the
artificial hormone oxytocin,ultimately increasing the risk
of cesarean delivery if labordoes not progress as expected.
A JAMA pediatric study done in2014 found that when epidurals

(04:09):
are administered early in labor,before four to five centimeters
dilation, which is typicallyaround the active labor phase,
the risk of cesarean deliveryincreases compared to later
administration, basically sayingtime your epidural to after you
are in active labor.
Epidurals work in that theyblock sympathetic nerve activity
, which can cause maternalhypotension when mother's blood

(04:33):
pressure drops.
According to American Societyof Anesthesiologists,
approximately 14 to 33% ofepidural recipients experience a
significant drop in bloodpressure.
That's a pretty big percentageand that can feel really, really
crappy when you're trying togive birth.
This hypotension can reduceblood flow to the placenta, of

(04:55):
course, leading to transientdrops in the baby's heart rate,
otherwise known as fetalbradycardia.
And guess what happens whenbaby's heart rate drops
significantly in labor?
What?
Boom, boom, we got to get thatbaby out.
That is usually the instinct.
They watch for a little bit.
But because you have anepidural and that's a continuous

(05:15):
flow, then that baby's heartrate is going to most likely
continue to be affected.
That is why continuousmonitoring of the baby's heart
rate is absolutely requiredafter an epidural is placed here
in Canada.

(05:38):
In rare cases with an epiduralthe needle that is placing the
catheter of the epidural it canpuncture the dura, which is the
membrane surrounding the spinalcord, leading to a significantly
severe headache known aspost-dural puncture headache,
and long-term complications caninclude back pain or nerve
damage.
Post-dural puncture headachesoccur in 0.5 to 2% of epidural

(05:59):
cases due to accidental punctureof the dermator.
This condition is welldocumented in regional
anesthesia and pain medicine.
If you are really curious aboutthat, I suggest that you go
read that article.
These headaches are severe andmay require a repair called a
blood patch where blood isinjected back into the epidural

(06:22):
space to seal that puncture thathappened from the placement of
the needle.
I've had this happen a fewtimes with patients in my
clinical care and the healingtime with this injury is long
and hard and, of course, you'regoing home with a baby and
you're suffering from theseextreme headaches.
It is not a very pretty pictureand I feel so much for those

(06:48):
moms who have gone home withthis.
Epidurals can sometimes causematernal fever, which may lead
to unnecessary antibiotictreatment for the baby after
birth.
So with epidural placement,sometimes women end up with a
fever and then that leads to theball rolling into antibiotic
treatment for the baby.

(07:08):
A 2000 study in anesthesiologyfound that women who received
epidurals had a higher rate ofmaternal fever.
That increased risk isapproximately about 15%, which
means you have a 15% higherchance of developing a fever if
you get the epidural.
This fever may lead to neonatalsepsis workouts, requiring your

(07:29):
baby after birth to undergoblood tests or even antibiotics
unnecessarily.
A study published in Birth in2011 suggested that epidural
medications, particularlyopioids like fentanyl, can
affect the baby's alertness androoting reflexes, leading to
challenges in earlybreastfeeding, which we have
seen quite a bit in the birthingworld.

(07:52):
Epidurals are considered thenorm in many hospitals, with
over 60% of laboring people inCanada opting for one.
But here's the thing manychildbirth educators who work
within the hospitals don't evendiscuss on medicated birth
options.
Why?
Because they view epidurals asthe default.
The normalization of getting anepidural often leads birthing

(08:15):
people unaware of alternativepain management like movement,
water immersion, breathingtechniques, massage, nitric
oxide.
Any of those other optionssometimes can be skipped over
because all that we're informedof is the epidural.
It also perpetuates the ideathat labor pain is something to
be avoided at all costs ratherthan a natural, manageable part

(08:38):
of the birthing process.
Now let's be clear.
I believe that epidurals havetheir place and can be a game
changer for many birthing people.
For example, epidurals canprovide relief from intense
labor pain, allowing you to restand conserve energy for the
pushing phase.
Epidurals can lower stresslevels, which can sometimes help
labor progress if your mama'sbody is just so tense and is not

(09:04):
relaxing at all.
No matter what you do,epidurals can be a lifeline in
prolonged or complicated labors,making the experience more
manageable and non-urgent oremergent.
For some people, an epidural isthe absolute right choice, and
that is absolutely okay.
The issue with epidurals itself, it's the lack of informed

(09:26):
choice and the over-reliance onit as the default.
One of the biggest concernswith epidurals is the potential
for a cascade of interventionsand that ball.
Once it's moving, it's hard tostop it.
And here's how that can playout You're in labor, you can't
take it anymore.
It's going well, progressingwell, but you're not coping well

(09:49):
with the contractions.
So you get an epidural.
You're able to rest.
Epidural slows down your labor.
And then we're faced with adecision.
So then the first thing thathappens typically is they will
administer Pitocin to strengthenyour contractions because labor
is stalled or slowing.

(10:09):
To strengthen your contractionsbecause labor is stalled or
slowing, then Pitocin leads tostronger, more painful
contractions.
And then you need more epiduraland also stronger contractions,
increased fetal distressrequiring continuous monitoring,
and if labor doesn't progress,a cesarean delivery is
automatically on the table.
It's one thing after anotheruntil it becomes a cesarean

(10:33):
section.
Now, this isn't to say thatevery epidural leads to this
outcome, but it's a pattern thatchildbirth educators and doulas
see often in hospital settings.
The key takeaway here is thatepidurals are neither inherently
good nor bad.
They're a tool.
The question is whether you'rebeing given all of the
information and all of theoptions to make an informed

(10:55):
decision.
Here's what you can do.
You can ask questions If yourprovider suggests an epidural,
ask about the timing,alternatives and potential risk.
Consider your birth plan, thinkabout how you want to manage
labor pain and discuss this withyour care team ahead of time.
I like to talk about a moment ofcrisis plan.
So, basically, what are wedoing when I first need help?

(11:18):
Is it the epidural?
If it is, go for it.
If that isn't your first choicefor the first crisis, play all
of those steps first.
Is it getting in the shower?
Is it movement?
Is it using nitric oxide?
Is it asking for some Demerol?
What is that first step whenyou first ask for a little bit
of help?
So those things are what wetalk about.

(11:39):
When you consider your birthplan.
Then we're going to explorenon-medical options.
Learn about techniques likebreathing, exercise, water birth
or using a doula for additionalsupport.
Now, when I talk about explorenon-medical options, that really
depends on the birthing centerthat you've chosen either the
hospital at home or an actualbirth center.
Some of these things are not anoption in every one of those

(12:01):
places.
You also want to advocate foreducation, push for childbirth
classes that present all optionsequally and are coming to you
on bias, including anunmedicated birth, if that is
something that you are tossingaround, or even if it's
advocating for the fact that youdo not want an epidural until

(12:25):
this moment in time or at thiscentimeters of dilation.
That's a wrap for today'sepisode of Tend and Be friend, I
hope this conversation aboutepidurals has helped you feel
more informed and empowered toask what you need to ask, and
remember the goal isn't to sayyes or no to an epidural.
It's to make a choice thatfeels right for you and for your

(12:45):
family, and for this birthspecifically.
Also, as an Amazon affiliate, Iearn a small commission if you
purchase through my links, butthis doesn't affect the price
you pay.
These commissions help supportthis podcast and that allow me
to keep sharing all the freeresources with you.
I only recommend products thatI genuinely believe in and trust

(13:07):
.
Thank you for all of yoursupport.
If you found this episodehelpful, please share it with a
friend, leave a review orsubscribe for more
evidence-based discussions onpregnancy and birth.
Until next time, take care andkeep nurturing yourself and your
village.
Let's talk soon.
Talk to you soon.
Okay, let's talk soon.