The modern woman is task-oriented. She lives in a world demanding of her competence, attention, and efficiency. We use technology, tap into our communities, plumb the depths of our reserves to navigate an often hyper-masculinized world while retaining our most vital feminine powers. The power that fundamentally defines our exemption from this contemporary lifestyle trajectory is baby making.
This primal empowerment forms the bedrock of a woman’s most untouchable gifts.
We have lost sight of this fact; however, and have allowed our inner compass to be co-opted. It’s certainly no wonder, that after 9 months of hypermedicalized pregnancy “management” (often following months to years of assisted reproductive technologies), birth is considered another task on the to-do list to complete.
As a type-A taskmaster, myself, I understand the lure of a predictable and painless depositing of your newborn after the long and fear-punctuated journey of pregnancy.
I’m here to tell you; however, what your obstetrician won’t.
Labor is a physiologic process that recruits neurochemical, endocrine, and immune systems into a dance that we barely have the tools to conceptualize.
When we meddle with this, when we attempt to standardize it, we put women and their babies at grave risk – physically, psychologically, and even spiritually. We rob women of an opportunity for psychospiritual transcendence.
As a science-minded medical doctor, I don’t wield this phrase with ease!
The process of conception, gestation, and birth cannot, however, be reduced to daily activities and routine life occurrences. There is something built into our consciousness that makes room for its own expansion around these life transitions. The process of bodily separation – woman from her newborn – involves a passage through a space of trance-like awareness.
I can only describe it as the sensation of floating and grounding, simultaneously. It is an experience that demands we move out of the space of our mind and into a space of sensation without judgment. It is being present, truly present, to behold a glimpse of what we are capable of as mammals and most importantly, as a human female.
In this way, a natural birth is an opportunity for redefinition and reconnection to one’s most core self. It is the way women were intended to pass through the gates of motherhood, to the next chapter of their actualization.
If you buy the potential significance of these considerations, you may want to know what represents your greatest obstacle and impediment in achieving this life milestone. You may be surprised to learn that it is epidural anesthesia. This discussion is meant to shine a light on elective epidurals – that, “Why not? Who wants to feel crazy intense pain?” choice that 2/3rds of women (and up to 90% in some hospitals) opt for every day. In my opinion, the epidural intervention is the most reprehensible of all – because of its largely dismissed risk profile, and because of its auspicious position in a cascade of interventions, unnecessary, ill-conceived, and rife with unintended consequences including death.
If we can empower women to question the validity of this procedure, then they can retain the right to preserve the integrity of their birth experience.
What’s the big deal with Epidurals?
A 60% rise in C-sections since 1996 is prompting the American College of Obstetricians and Gynecologists to fidget self-consciously in their white coats. A study revealing the prolongation of the second stage of labor thanks to epidurals has been influential in identifying the iatrogenesis – doctor-caused harm – at the root of the cesarean problem.
It appears that, thanks to an antiquated but still sanctioned construct – Friedman’s curve – the hospital clock starts ticking loudly upon arrival, and the alarm goes off after 3 hours of second stage labor with an epidural. At this non-evidence-based juncture, interventions including IV fluids, continuous monitoring, food and drink restriction, and immobilization conspire to invite pitocin, forceps, episiotomy, and surgery into the delivery room.
Obstetrics is vulnerable to practicing consensus medicine – habitual practice that is not predicated on sounds science. As I discuss here, metanalysis has demonstrated that only 30% of current obstetrical recommendations are based on quality data. What’s the rest based on? Fear-mongering and personal opinion? Let’s look at what the evidence suggests about the risks of epidurals, considering that up to 41% of women never properly consented for this intervention.
Epidurals are offered with a plethora of accoutrements including catheters for involuntary urination, blood pressure monitoring and IV fluids for changes to vascular physiology, and continuous fetal monitoring because of risk to the baby of decreased oxygen flow.12
The changes to natural labor progression are compounded by risk of fever in the mother that leads to further separation of mom and baby after birth, secondary to testing and assessment for infection. This separation represents a stress to the shared adaptation to early postpartum life and may predispose to psychiatric pathology in both mom and baby through early epigenetic influences on gene expression.345
This separation may also interfere with breastfeeding establishment. In this way, epidurals may be directly and indirectly responsible for breastfeeding struggles67. Breastfeeding appears to prevent the onset of postpartum depression if it is established within 3 months, in addition to being a continual source of immunologically essential information trafficked from mom to baby.
Shooting Up You and Your Baby
Epidurals are a delivery method for narcotic pain-killers that pass through the placenta to the baby and have largely unpredictable effects on the birthing woman. Evidence supports risks to the baby including reduced tone, poor feeding, jaundice, withdrawal, and sensorimotor impairment.8
Physiologic risks to the mother include acute and persistent problems such as numbness, tingling, dizziness, respiratory paralysis, cardiac arrest, nerve injury, abscess, and death.910A user-friendly description of these considerations was explored by Pathways to Family Wellness, here.
When epidurals lengthen the second stage of labor, Pitocin, or synthetic mimic of the brain hormone, oxytocin, is delivered to augment the process. Because Pitocin does not cross the blood-brain barrier, it does not stimulate endorphin release. It also interferes with feedback loops suppressing natural oxytocin production while hyperstimulating the uterus without appropriate relaxation between contractions. The significance of this is just being revealed and may even reach to risk factors for autism.
The increased risk of c-section1112 in the wake of epidural anesthesia is easily explained by relaxation of pelvic muscles that detach a woman from the instinctive guiding forces of an uninhibited labor, by the baby’s increased distress secondary to narcotic exposure and malposition, by the recruitment of Pitocin which causes uterine and therefore fetal distress, and fetal monitoring which, while superficially reassuring results in increased interventions (2-3x c-section rate) without improved outcomes.
Your doctor may fail to mention that a surgical birth brings with it these risk considerations: protracted recovery, infection (including necrotizing fasciitis), organ damage, adhesions, hemorrhage, embolism, hysterectomy, wound dehiscence, early infant separation, higher risk of respiratory problems for baby, and an exponentially increased risk of placenta accreta, a potentially lethal complication of surgical birth, contributing to a 3.6 fold increase in maternal death after cesarean relative to vaginal birth.
Of primary interest to clinicians who appreciate the role of the gut microbiome in child and adult health, abdicating a vaginal transfer of beneficial bacteria may set the stage for chronic disease including a 20% increased risk of obesity.
Opting out of epidural anesthesia: Choosing to feel
What are the best ways to help your body, mind, and spirit align for this tumultuous but life empowering journey?
Movement – Staying active during pregnancy is optimal mind-body medicine. Yoga, home-based routines, and swimming in unchlorinated water are excellent choices, at least 3 times weekly.
Chiropractic – With advanced perinatal training, holistic chiropractors are critical experts in proper alignment and nervous system support to facilitate a physiologic birth.
Acupuncture – Applied before and even during labor, acupuncture can gently and effectively facilitate a healthy labor and delivery. According to a Cochrane Review, acupuncture and hypnosis meet evidence-based efficacy criteria for pain management in labor.
Controlled Breathing/Meditation – Perhaps the most important tool for a new mother, learning to engage the relaxation response in pregnancy will help you to know what it feels like to be present to the labor experience, to go inward, quiet your mind, and release fear. Hypnobabies and hypnobirthing are well-regarded methodologies. If you are extremely anxious, breathing small amount of nitrous oxide mixed with oxygen can help.
Diet – The physical experience of labor and delivery is best supported by stocking the shelves up front for a healthy hormonal response with minimization of inflammation and maximization of nutrient-density. Eat sustainable, organic meat, fish, eggs, veggies including root vegetables and squash, fruit, nuts, and seeds. Leverage the complexity of food-based information to promote optimal gene expression in that growing baby, and support a healthy delivery and postpartum experience.
Doula – Preparation for labor, and support for mother and spouse have been traditionally left in the hands of a woman’s most doting partner, a doula. No woman should birth in a hospital without this advocate. Evidence supports a doula’s ability to help you achieve an intervention-free birth.
While my most heart-filling emails every day are from my homebirthing patients, I aim to sit in a place of true advocacy for the women that I treat and advise. I believe in informed consent, and I observe that this is not occurring in hospitals today. Explore resources that will help to expose you to the known risks and popularized benefits, so that you are making your own decision with your eyes wide open.
As most women who have experienced natural birth would attest – just when you think you can’t do it and your mind demands surrender – you meet your baby, and the world stands still in a moment of unparalleled beauty and wonder.
The Toxic Effects of Water Birth on Mom and Baby
6 pregnancies. 6 natural births. The first of which was a frank-breech. I am a very stubborn woman!
You make the statement that there is an “increased risk of caesarean section in the wake of epidural anaesthesia” and then cite two articles which do not support this hypothesis. The Cochrane review you cite specifically concludes “Caesarean delivery rates did not differ overall and nor were there effects of the epidural on the baby soon after birth; fewer babies needed a drug (naloxone) to counter opiate use by the mother for pain relief.” and the Kotaska article found there was no increased risk of caesarean section following epidural in 7 of 8 studies he analysed, and an increased risk in 1 study. Very sloppy.
I have been a childbirth professional (as a massage therapist, doula, educator & activist for over 11 years. This is one of the best pieces I have ever read. Thank you so much!
I WISH someone had shared this kind of info with me 8 years ago, when my first was born. He was induced (at 38 weeks), because my doc thought I couldn’t handle the pregnancy anymore (and convinced me of it). Then I was given epidural, then they ‘accidentally’ put a LATEX (I’m allergic) catheter in, which I made them remove about 10 minutes later, but I was already swollen and in trouble from it. Then I refused another catheter, and went to the bathroom. After that, they said my sons heart-rate bottomed out (from what I know now, probably faulty with the equipment because of my moving and the catheter issue. Then I got a lovely emergency C-section. 14 months later when my second was born, my water broke and my body never actually went into labor… yet another induction with pitocen, this time the epidural didn’t work because of scar tissue (another risk they don’t tell you about), then my daughter got STUCK literally because my pelvis didn’t widen the way it should have, then of course, followed another emergency c-section… I warn every pregnant and might get prego woman I know about staying away from induction, epidurals, and looking into a more natural birthing process then most hospitals offer.
Hi. Am not not pro-epidural for everyone. I didn’t use it for my second birth and I breastfed with absolutely no problems for 20 months and yet I still ended up with postnatal depression. So blaming the epiduaral for causing depression and crediting breastfeeding with preventing it is a bit wild. I’m a midwife and childbirth educator and support my women with all their choices without passing scare techniques and personal opinion onto them. Most women would prefer not to have one and personally I don’t like them either and would rather support and coach a woman in other ways. However, it is not my birth experience and not my place to judge. For those women who need it and who are informed of realistic pros and cons the epidural can make an amazing difference and some feel more positive about their birth experience because they used this option.
But what can be done to help the women that has been laboring at 10cm for hours, when positions, water nothing works for her….
I have attempted 2 drug free births. Used hypnobirth, done yoga, swam in the ocean regularly and of course eaten a diet of non gmo and organic food. Both births ended in epidurals. By request. I strongly feel women can birth babies with no intervention. Me however is another story. We will see with baby 3 eventually.
Granted both my babies were not born in typical presentation. Maybe I am not meant for that path…
I’m not sure what study the author is trying to cite above, since none comes up when I click, but it’s well established that epidurals given *after 4 centimeters* do not increase your chance of a c-section and they only lengthen labor by an average of 15 minutes. Here’s the “gold standard” on epidurals, a massive meta-analysis that came out in 2011. I’ve read the actual study but I don’t own the rights to post it here, so this is the abstract:
For a much better explanation of why our c-section rate is “high” see this and the 26 sources cited therein:
I have no doubt that the rise in epidurals and the rise in C-Sections is the major cause for why all of the sudden the NICU’s are full to capacity all the time. 10 years ago you rarely even heard of a NICU. Now every baby goes there for some reason. Strange happenings instead of letting nature do her thing. I let nature do her thing with three births and don’t regret a minute of it. And my first baby (born in 1975) was breech and face-up presentation. All I had for “anesthesia” was pure oxygen. The doctor tried to turn her around, but that wasn’t happening so he just let her come naturally. Nowadays I have no doubt they would have rushed me into a c-section and who knows what the consequences would have been. I’m so glad I’m done with this part of my life. My DIL is studying to be a doula and I will certainly share this information with her.
Thank you so much for broaching the subject. It NEEDS to be talked about and discussed by more women – at length.
DECADES ago I asked someone who was an expert in childbirth techniques what she considered was the best method: “Don’t go near a hospital” was her response.
Boy, was I surprised at that – but not any longer……