Should You Get an Epidural?

Having a baby is an inherently painful proposition.

I speak from experience here.

Pain medication is then infused, pleasantly numbing the nerves signaling pain from the uterus and birth canal.

(Contrary to popular belief, theresno evidencethat epidurals cause a long-term backache.)

Epidurals also change the experience of labor.

Does an epidural make you more likely to have a c-section?

The question of how epidurals affect the course of labor is complicated and controversial.

But observational studies can only show correlations between variables; they cant show that one caused the other.

It does not mean the umbrellas cause rain.

Similarly, more women who have epidurals have cesarean deliveries.

It does not mean the epidurals cause cesareans.

Its a classic chicken or egg problem.

Which came first, the epidural or the difficult labor?

It would also be unethical to deny study participants pain relief for the sake of science.

On rainy days, more people carry umbrellas.

It does not mean the umbrellas cause rain.

So, researchers have had to find other ways to study this question.

The2011 Cochrane reviewdid find that epidurals were linked to use of forceps or vacuum during birth.

Modern epidurals use lower doses, and with these, there seems to beno increaseinforceps or vacuum use.

That bothered Philip Hess, director of obstetric anesthesia at Beth Israel Deaconess Medical Center in Boston.

There was no difference in the duration of labor or in the incidence of C-section or forcep deliveries.

But if epidurals do slow labor, its possible that effect was in play in both groups of women.

Caughey was one of the authors of a2014 observational studythat found labors with epidurals were quite a bit longer.

But, he points out, The goal isnt necessarily a short labor.

The goal is an enjoyable experience to some degree.

And sometimes, an epidural may even help a stalled labor move forward.

In this situation, pain relief and the ability to rest may be just what you need.

Wong and collaborators published arandomized controlled trialearlier this year that is reassuring on this front.

They tested several different concentrations of opioid in epidurals and found no effect of dose on breastfeeding rates.

With my second, labor was faster and easier, and an epidural just didnt feel necessary.

In both, I was grateful to have the option if it was needed.