Epidural Without Guilt

Epidural Without Guilt is the book that takes the fear and mystery out of pain relief for childbirth. In this groundbreaking work, Dr. Gilbert Grant analyzes the latest medical studies about pregnancy epidurals and spinal epidurals, and presents them in a commonsense, reader-friendly format. Dr. Grant delivers a completely new way to look at pregnancy epidurals. Instead of focusing only on the risks of getting an epidural, he discusses something few people ever consider: the risks of NOT getting one. Epidural Without GuiltMothers-to-be and even health care professionals may be surprised to learn epidural information:

  • Can speed up labor
  • Do not increase the risk of cesarean
  • May reduce the likelihood of postpartum depression
  • Can help with breast-feeding

Pregnancy Epidurals

Spinal Epidurals

Five Epidural Myths

Although most women in the U.S. use pregnancy epidurals (and/or spinal epidurals) to relieve the pain of childbirth, myths about pregnancy epidural procedures abound. Unfortunately, these myths cause more than a little consternation for many pregnant women. Much time is spent worrying not only about the pain of labor and delivery, but also about the methods to relieve the pain. Here are five of the most widely held myths about epidurals:

* Epidurals will slow down my labor

This is a commonly believed myth, but in fact is not true. Since 2005, there have been four scientific studies published on this issue. Three of the studies found that instead of slowing down labor, pregnancy epidurals and spinal epidurals actually speed labor up – especially when pregnancy epidurals are given before the cervix is 4 cm dilated. The fourth (and largest) of the studies showed no difference in how long labor lasted, whether or not a pregnancy epidural was used. So pregnancy epidurals do not slow labor down – they may even speed it up.

* Epidurals will increase the chance that I will need a cesarean

This is an old myth will not go away, even though many studies from different parts of the world have found that pregnancy epidurals do NOT increase the chance of needing a cesarean. So why all the confusion despite solid scientific evidence? It’s because pregnancy epidurals are associated with cesareans, but they don’t cause cesareans. What do I mean by this? Well, women who have difficult, painful labors are more likely to need a cesarean. And these are the SAME women who are more likely to ask for a labor epidural – so there is an association between labor epidurals and cesareans. But the labor epidural does NOT make a cesarean more likely.

* Epidurals will cause backache

It turns out that backache is very common during pregnancy and after pregnancy. In fact many women experience backaches after they deliver that can last for many months. Scientific studies of backache after delivery have found that the chance of having a long-lasting backache is the same whether or not the mom got a labor epidural.

*Epidurals are dangerous for my baby

This is a particularly wicked myth, because it makes women feel guilty for wanting to their pain relieved. Although there are certain problems with labor epidurals that could be bad for babies, for example, a significant lowering of the woman’s blood pressure – most effects of labor epidurals are actually helpful for the baby. An example of this is the labor epidural lowering the woman’s stress level and thus getting more blood flow and oxygen to the baby during labor and delivery.

*Epidurals will prevent me from breastfeeding my baby

I hear this myth repeated all the time, but the scientific evidence is scanty, at best. Modern pregnancy epidurals and spinal epidurals use such low doses of medication that it’s hard to imagine a negative effect on breast-feeding the newborn. In fact, pain after delivery can be bad for breast-feeding. Pain reduces the amount of milk a new mother produces. And a new mom in pain may be less likely to want to interact with her new baby. So I suggest something that isn’t usually considered: think about using a very low-dose labor epidural after a difficult vaginal delivery, and certainly after cesarean. It’s the best way we have to make the mom comfortable without being drowsy.

Myths about pregnancy and epidurals have been around for years, and some are so widely believed – even by obstetricians, midwives, nurses, and others–that they’ve taken on a life of their own. During pregnancy, every woman is exposed to one or more of these myths. This is unfortunate, because hearing these myths – and believing them – influences a mother-to-be’s decision making about pain relief options. Decisions should be made after considering the facts  about pregnancy and epidurals – not the myths.

Gilbert J. Grant, MD, an obstetric anesthesiologist in New York City, is author of Epidural Without Guilt: Childbirth Without Pain.

Pain Control and Breast-feeding

Most mothers-to-be plan to breast-feed their babies. While there are many different factors involved in successful breast-feeding, one factor that is not usually even considered is the pain that a mother may experience after delivery. In fact, if the pain is severe, it can be a very important factor in whether breast-feeding is successful or not.

* The pain of childbirth doesn’t end at the moment of delivery.
Pain is common after both vaginal and caesarean delivery. After vaginal delivery, the pain is most severe in the tissues of the vagina and the perineum. For women who have had episiotomies or tears, the pain is even worse. After a caesarean, the pain is felt mainly in the abdomen, at the incision.

* Whether you have a vaginal or caesarean delivery, the uterus continues to contract after your baby is born, and breast-feeding actually increases that pain.
The contractions that return your uterus to its non-pregnant state hurt. And these contractions (called “after-pains”) are intensified by breast-feeding, an act that causes the release of oxytocin–the body’s natural pitocin–from your pituitary gland. So breast-feeding itself causes you more pain. And the pain that occurs during breast-feeding gets worse with each subsequent baby you have. Women that have many children say that the after-pains can hurt even more than labor.

* When humans experience pain, they aren’t at their best to interact with others, which makes it more difficult to nurse.
Most people suffering from pain would just like to curl up in bed and not deal with anything else. But if you’re a new mom, there’s a newborn counting on you to take care of it. If you have people to help you, for example, the nurse at the hospital, and they can give your baby a bottle, that’s fine. But if you want to breast-feed, you’ll be better able to focus on it if you’re not in pain.

* Any pain medication the mother takes gets into the breast milk and reaches the baby; if it’s medication that makes the mom drowsy, it will also make the baby sleepy.
A post delivery epidural will relieve much of the pain–and without the harm to the baby that other pain medications will cause. That’s because with a pre or post delivery epidural, unlike with oral or intravenous medication, only a very small amount is required to relieve the pain, because it is administered right next to the nerves that carry the pain signals.

Successful breast-feeding depends on many different factors. Post-delivery pain experienced by the mother is one factor seldom considered — but it should be. Controlling the pain may help to improve the chance of breast-feeding success. And the best way to control pain is with a post delivery epidural. Find out if the hospital where you will be having your baby gives you the option of receiving post delivery epidural medications after you deliver.

Gilbert J. Grant, MD, an obstetric anesthesiologist in New York City, is author of Epidural Without Guilt:Childbirth Without Pain.