More about Labor

The previous entry detailed the basics. There is, of course, so much more to say about labor and birth.

Back Labor

I have never experienced back labor, but I have heard plenty of times that it is excruciating. Back labor is most often caused by the baby being in the wrong position for birth. The normal position is head down with the baby turned towards the mother's back and the baby's back facing outwards towards the mother's abdomen. If the baby is reversed - that is, with the baby's spine facing the mother's spine - the bony part of the baby's skull presses down on the mother's tender nerves, causing pain that shouldn't be there. Sometimes this can be remedied with walking and rotating the hips, or swaying on a birth ball. The pain can be partly relieved by getting on all fours and taking the pressure of the baby's head off of the mother's nerves. Counter-pressure - having an assistant press hard on the lower back - usually helps. If the baby does not rotate to the favorable anterior position, the baby will be born "sunny side up", and this might extend the pushing phase.

Epidurals

Epidurals are an extremely common form of pain relief for labor. They are typically administered between 4 and 7 centimeters of dilation. The mixture of drugs used is unique to every woman, and epidurals must be given by an anesthesiologist. The process usually takes about 45 minutes to an hour and a half to complete. The epidural is given directly to the spine. The procedure is basically as follows: an area on the mother's lower back is cleansed and a thin catheter is threaded between two spinal vertebrae into the column of fluid surrounding the spinal cord. The anesthesiologist gives a test dose to ensure the placement is correct, then tapes the catheter cord to the mother's skin. The epidural mixture is either given in doses by the anesthesiologist as needed, or it is given in a drip that can be controlled by the mother.
I am not altogether opposed to epidurals. I think they are overused, and I am stunned to hear of women who want epidurals before they have ever felt a single contraction. It seems to me that these women would be better served in facing their fears of childbirth instead of beginning motherhood in a drugged-up state. I believe that epidurals ought to be administered when the mother is overtired and her exhaustion is affecting the progress of labor, or if she suffers from back labor. I wish they were not given as a matter of course, giving women the impression that they are unable to endure labor and need drugs to help them through it. For the women for whom this is true, they should be available, but I refuse to believe that this is the case for most pregnant women.

Effectiveness of Epidurals

For most people epidurals are a very effective way to obtain pain relief during labor. The epidural numbs the mother from the top of her uterus all the way down to her feet, and often the mother will feel pressure during contractions but no pain.

Potential Risks and Side Effects

Epidurals dramatically lower the mother's blood pressure, so an IV is given at the same time to counteract this effect. Because she is numb, the mother will no longer be able to walk or change positions unassisted. Epidurals tend to slow down the progression of labor, and so they are associated with an increased use of pitocin, an artificial oxytocin used to increase the rate and strength of contractions. Occasionally the mother will not be able to feel her pelvic muscles well enough to assist with pushing the baby out (another reason to practice those Kegels!), and forceps or a vacuum extractor will be required; at worst, she will need a cesarean.The rate of complications with epidurals is estimated to be 23%. Most complications are problems with administration and are not inherent to epidurals in general. Some are life-threatening, but those of course are extremely rare. In truth no medical procedure is free of risks.One of the common complications is punctured dura, meaning the spinal cord itself may be punctured during the administration of an epidural. Spinal headaches will result, which are extremely painful and can last for a very long time - I have heard of spinal headaches persisting for as long as a year after delivery.

Some medical practitioners tell women that the epidural does not pass to the baby and therefore cannot affect the baby, which is an outright lie. Epidurals given too close to the delivery of the baby tend to depress the baby's respiratory system, requiring some level of resuscitation. Having a drowsy, uninterested baby is not ideal during the crucial first hours after birth, when bonding between mother and child is so important and can be so beautiful.

Occasionally the epidural has no effect on the mother, which means she faces both the disappointment of not being able to obtain relief and the daunting task of having to deliver a baby naturally. I believe that it is in the mother's best interest to mentally prepare herself for a labor without pain medication, even if she plans to get an epidural, just in case the epidural has no effect on her. The judicious use of epidurals can make the difference between a mildly disappointing event during an otherwise joyous occasion, and a traumatic birth experience.