Jessica Girado

What you probably want is to avoid pain. Epidural anesthesia is by far the most effective pain relief option during labor. But while it eliminates pain on the front end, it may cause more on the back end.

Here’s an example. You get the epidural and all the labor pains go away. The epidural slows down contractions, so they give you Pitocin to speed things back up. Soon it’s time to push. The nurse lowers the bed and has you put your feet in stirrups, with your knees up. She watches the monitor, and when a contraction hits, she tells you to hold your breath and push until your face turns purple. You can’t really feel what’s going on, just pressure, and after several pushes the baby finally comes out squawling — you did it! “Second-degree laceration,” you hear the doctor say. Or worse, you hear, “Let’s repair the episiotomy.” Because you couldn’t feel how you were pushing, and because your provider had you flat on your back and put no counterpressure on your perineum, you tore (or were cut, or were cut and tore some more.) Or even worse, they needed to use a vacuum or forceps to supplement your pushing and get the baby out. And you will now be stitched. If the anesthesiologist did a good job, you still don’t feel a thing. But just wait. When that epidural wears off and you feel those stitches down there — OUCH! Many women have said that recovering from stitches is worse than the labor itself. You can’t sit, you’re afraid to poop, and sex hurts for months.

Here’s another common scenario: you get the epidural, contractions slow down, they pump up the Pitocin, break your water, and 6 hours later the baby just isn’t descending, and his heart rate is dipping. Epidurals contribute to what’s called “malpositioning” of the baby. And when this happens, the recourse is often a cesarean section. Again, you probably won’t feel much during the surgery, but then the drugs will wear off. The recovery can be grueling. Your abs have been severed, and without those muscles it will be difficult to even pick up your babe. If you’re the 1 in 5 who contract an infection post-surgery, the pain and nastiness will be even worse.

The bottom line is that childbirth is a huge physical act that involves pain for most who experience it. But the pain of labor, it turns out, is important. It is hormonally tied to healthy labor progress. If you take away the pain, you may take away the progress, which requires intervention that can cause harm (and more pain!). Your doc/friend/mother-in-law may be saying, “Don’t be a hero, get the epidural!” But this isn’t about heroics, this is about protecting your body. It may turn out that after hours of labor and every other trick in the bag, an epidural is just what it takes to facilitate the baby’s debut. But research suggests it’s best left as the serious medical intervention it is — taken when really needed.

That’s not to say that women who shoo away the anesthesiologist don’t need help getting through the pain — massage, a deep warm tub, a shower, hypnosis, and relaxation techniques can all help. Most importantly, you need to be able to move your body. What you don’t need is to be stuck in a situation with access to none of these options, or in a hospital bed with an electronic fetal monitor tying you down and a Pitocin drip in your vein. Indeed, if you’re pushed, an epidural may be the only way you can get through it. It’s nonsensical to expect a woman to labor without drugs if she’s strapped flat on her back.

That’s why it’s imperative to line up a supportive provider and atmosphere before labor starts. Women who get this kind of support are more able to stay upright, active, and in control of pushing, and are more likely to have an uncomplicated birth, an intact vagina, and a speedy recovery.