Epidural or Don't | Weighing Your Options

In the "crunchy" world of birth, epidurals can sometimes carry a negative connotation. Many parents opt for less invasive forms of pain management in lieu of epidural anesthesia. The list of reasons some wish to avoid an epidural is long, but are there benefits? YES! Let's chat about your personal reasons to get an epidural, or not. In this post, we won't dive deep into the research (places like EBB do that best), but instead we'll talk about the common personal reasons why someone may be for or against an epidural. In addition, we'll discuss how an unplanned epidural may be the best choice for the circumstances in your birth. 

Reasons to Avoid an Epidural

There is no way one person can give an exhaustive list of why some parents want to avoid epidural. Birth choices are so incredibly personal! However, here are some common reasons you might set out for an epidural-free birth: 

• Freedom of movement - Choosing an epidural means limiting your mobility. You're no longer able to walk and may have difficulty feeling your legs. This limitation in movement may make some parts of labor more difficult. 
• Desire to have full control over body - Some parents need to know they are in control of their own bodies and all bodily needs. Without an epidural, the laboring person can feel what's happening to them and can have autonomy over movement and bodily needs. 
• Freedom to eat and drink - Most of the time, after an epidural has been placed, your diet is restricted to clear liquids only.
• Fear of medical risks - There's nothing without risk. You can read about some of the risks here prepared by Johns Hopkins Medical. 
• Avoidance of opioids - For those who are in recovery or who actively refuse opioids, this can be a major reason for opting against an epidural. While the opioid medication used in an epidural doesn't alter your cognition, some still want to avoid it. In addition, some parents worry about the level of fentanyl that crosses the placenta and gets to baby. 
• Desire to experience unmedicated birth - Some parents truly just want to experience an unmedicated birth. 
• Decrease risk for interventions - Getting an epidural is known to lead to an increased risk of other interventions. By refusing the epidural, you can help mitigate the risk for undesired interventions.
• Fear of needles - Some are simply afraid of needles and the procedure. 
• *your reason here*

These are common considerations for people who want to avoid epidurals. All reasons are completely valid and I always support my clients' decisions for what pain management is best for them. So... if all of these reasons are valid, why would someone ever want an epidural? 

Reasons to Want an Epidural

Like the list above, the reason(s) you may want an epidural are personal. Whatever your reason, it's a fine enough reason to ask for it! Here are some common reasons why parents I work with want an epidural: 

• Most effective pharmacological pain management option for labor - if you know you want some pharmacological help managing pain, epidurals are typically the most effective. 
• Fear of childbirth - For some, fear of the process can lead to anxiety and more pain. For these people, choosing an epidural can help them remain calm and feel less afraid. 
• Desire to "enjoy" the process - Those last few hours before baby arrives are precious, and sometimes parents just want to spend them together, without having to think too much about what's going on. Some parents say epidurals help them enjoy the birthing process more. 
• Lack of support for unmedicated birth - For those who don't have support from a dedicated partner, and maybe even their medical provider, to have a planned unmedicated birth, an epidural can be a wonderful option. 
• Desire to not associate baby with pain - For most, unmedicated labor comes with pain. Some parents are afraid they will associate pain with the baby and would like to opt for choices in labor that keep their pain experience low. 
• Scheduled cesarean birth - If a cesarean birth is scheduled or suspected, an epidural is often chosen. 
• *your reason here*

Making the choice to have an epidural in labor is something I hope all families feel empowered to do if that's what's best for them. A birth with an epidural is a birth (just like a cesarean is a birth). The method of birth and the details that surround it, while important to you, do not devalue you or your experience.

Unplanned Epidurals in Labor

Now that we've discussed some reasons some people plan for or against epidural, what about those who set out hoping for an unmedicated birth, but end up with an epidural? What are some reasons that may happen and what are the benefits? 

• Exhaustion - Many times, I've support families who desire to have an unmedicated birth, but for reasons outside of their control, they're pushed to the limits of exhaustion. Sometimes labor can be very long, and parents are unable to rest. Labor is hard work and it is physically demanding! In these situations, an epidural is a very compassionate choice. Rest by way of epidural is a really beautiful thing and may help you achieve a vaginal birth.
• Inability to cope with the pain of labor - For a plethora of reasons, pain from labor may not feel manageable without an epidural. If the person in labor decides this is the best choice for them, they should be supported.
• Unexpected cesarean - Your birth is as unique as your baby and sometimes a cesarean birth is the most safe method of birth. Having an epidural already in place can make this process a little easier. 
• Necessity of other medications - Some medications may make it harder to labor without pain management because mobility is impacted or intensity of contractions is amplified. The need for drugs like magnesium to treat preeclampsia or pitocin to strengthen contractions, cause some parents to change their preferences on epidural. 

Ultimately, You Choose

Whatever your choice, I hope you feel supported and that you make the best decisions for the birth you're given. We don't get to choose our birth experiences, but if we prepare ahead of time by familiarizing ourselves with the process, it can help us make solid choices and feel good about them when unexpected circumstances arise.