How Safe Are Epidurals?
I'm pregnant, and a lot of the women I talk to are choosing to have an epidural during labor. I'm really afraid of pain and am leaning toward having one myself. What do you think? Are they safe for my baby?
Epidurals, which can block pain sensation in the pelvis, are performed by injecting medication through a space in the spinal column during labor. A woman can receive different types of epidurals, depending on the circumstances -- whether it is a routine vaginal delivery, a cesarean section, or an unexpected complication. In general, they don't affect a woman's ability to control her muscles during childbirth, and epidurals are much safer than they were in the past. However, some obstetricians still caution that since we don't know exactly how much medication gets passed to the baby, we can't quantify the risks involved. Other critics believe that having an epidural can lengthen labor and/or compromise a woman's ability to push the baby out, thus increasing the need for a cesarean section. Objections also come from doctors and midwives who believe epidurals deprive women of experiencing a natural delivery, which they view as empowering and transforming.
Nevertheless, more and more women are opting for epidurals these days. Results of a survey presented at a recent meeting of the American Society of Anesthesiologists (ASA) showed that between 1981 and 1997 the number of women given epidural anesthesia at large hospitals tripled to 66 percent from 22 percent; at smaller hospitals the epidural rate doubled from 21 percent to 42 percent.
Although many doctors and midwives steer women toward natural childbirth whenever possible, mothers who are afraid of the pain, or decide upon an epidural during a long and painful labor, should have the option. The new epidurals take effect much more quickly than older ones, and often provide pain relief within seconds of administration.
Incidentally, you should be aware that every woman is entitled to pain relief during labor should she want it. An instance of a Los Angeles woman being denied an epidural because she could not prepay for it made headlines in 1998. Afterward, both the ASA and the American College of Obstetricians and Gynecologists issued a joint statement addressing the Los Angeles case, as well as reports of some insurers refusing reimbursement for epidurals that weren't documented with a "medical indication." Both groups agreed that a woman's request for pain relief is sufficient justification for giving her an anesthetic.
I suggest that you discuss epidural anesthesia with your obstetrician and, if possible, with an anesthesiologist. However, I also recommend taking Lamaze classes, which teach breathing exercises and other relaxation techniques to make labor and delivery less painful.