At mindbodygreen, we gravitate toward holistic healing and natural practices. But we also know that wellness isn’t one-size-fits-all. Whatever works for you, we support. Most of all, we don't think anyone should feel ashamed for the health choices they make.
Dr. Amy Tuteur, a Harvard-trained obstetrician-gynecologist, has long been in the spotlight voicing her opinions about childbirth and parenting issues. In her new book being released today, Push Back: Guilt in the Age of Natural Parenting, she encourages women not to feel guilty for their decisions, even if they aren’t considered the “natural” choice. In this piece for mindbodygreen, Dr. Tuteur takes on what she considers to be one the biggest sources of mommy guilt and a big topic of her book: the decision to have an epidural during childbirth.
Let’s get this straight: There’s no reason to feel guilty if you have an epidural to relieve pain during childbirth.
How do I know this? I’m an obstetrician-gynecologist and former clinical instructor at Harvard Medical School as well as the author of a new book on motherhood and guilt. Most importantly I’m a mother of four, all of whom were delivered vaginally—two with epidurals and two without.
Through all my professional and personal experiences, I've learned that the critical difference between giving birth with an epidural and giving birth without an epidural is … the pain!
I know that might come as a surprise to many people, especially because we're so used to hearing that “natural” is always better—but that’s what the scientific evidence shows. Here’s what else I wish more women knew about epidurals and childbirth:
1. Epidurals do not increase your risk of C-section.
Epidural is actually a technique—not a specific drug—and so the effect of epidurals depends on what medication is injected into the back to bathe the nerves exiting the spinal cord.
Originally, local anesthetics were used in epidurals; it abolished the pain, but it also interfered with muscle function and a woman’s ability to push the baby out. For more than two decades, however, epidurals have used a combination of local anesthetic and pain medications, providing excellent pain relief with only minimal effect on muscle function.
The issue has been studied extensively—and a 2011 Cochrane Review of 38 randomized, controlled studies concluded that epidurals did not increase the overall risk of C-section.
2. Epidurals are safe for babies.
Unfortunately, it’s often implied that women who get epidurals are “drugging” their babies. That’s simply untrue. The medication is not injected into the bloodstream and only a small amount eventually makes its way into the mother’s circulation; even less crosses the placenta.
If the mother is not sedated in any way by an epidural, the baby cannot be sedated, either.
3. Childbirth pain is not “good pain.”
There is no scientific evidence that childbirth pain is beneficial to babies or to mothers in any way. Some people try to distinguish the severe pain of childbirth from other types of pain on the theory that it’s “natural” pain—but all pain is natural pain. Pain exists as a natural mechanism to warn and protect people from harm.
Childbirth pain is just like other forms of pain in all respects. It’s carried by the same type of nerves. It involves the same neurotransmitters. It ascends the spinal cord on the same pathways. It’s processed in the brain in the same areas. There's no difference between childbirth pain and any other pain.
4. There's no evidence that childbirth pain is involved in mother-infant bonding.
Human infant attachment has been studied extensively, and it has nothing to do with how a baby is born—as any adoptive mother could tell you. The mother-infant attachment forms naturally and spontaneously between an infant and the person he or she depends on to provide care. Pain has nothing to do with it.
Still, epidurals do have risks. Every pain medication or medical procedure to treat pain has risks. That’s why they shouldn’t be used unless the benefit outweighs the risk. For example, morphine for pain after surgery can interfere with breathing, but we don’t withhold it, because the large benefit of treating severe pain outweighs the small risk of breathing difficulties.
The biggest risk of an epidural is a spinal headache. About 1 percent of women will experience a spinal headache and it is pretty uncomfortable, though not nearly as uncomfortable as childbirth. A spinal headache usually goes away on its own, but there are techniques that can be used to treat it.
Epidurals have also been shown to prolong the second stage of labor and raise the risk of vacuum-assisted or forceps deliveries. When I was practicing and a patient found that she couldn’t push effectively with her epidural, I counseled her about turning it down or off. The pain returns, of course, but often the mother can push the baby out without assistance.
The bottom line is that there is never any reason to feel guilty about having an epidural. The pain of childbirth does not benefit the baby and does not benefit the mother. Men don’t feel guilty about treating their severe pain; women shouldn’t feel guilty, either.