The U.S. has the highest infant and maternal mortality rates compared with any other high-income country, even though we spend the most on healthcare. Black women are dying at a rate that is 3-4 times higher than the rate for White women. There are a lot of problems in our maternity care system. It’s complicated and messy and deeply layered. There’s no easy fix.

We believe that childbirth education plays an important role in improving birth and changing statistics. We want families to educate themselves, to know their options, use their voices, and demand better care. 

Hollie Hauptly (CEO) and Cheryl Amelang (Certification Coordinator) teaching the online Comprehensive Birth Class.

In September, our CEO, Hollie Hauptly, and Certification Coordinator, Cheryl Amelang, had the amazing opportunity to present at DoulaCon in Denver, Colorado. The presentation was titled, “Harnessing the Power of Childbirth Education to Foster Positive Birth Experiences and Improve Maternal-Infant Outcomes.” Here at Birth Boot Camp, we firmly believe that childbirth education can create positive birth experiences! With the knowledge and confidence parents can gain from a childbirth class they can make informed choices during childbirth which will help improve maternal-infant outcomes. In this 10-week series, we will break down and discuss the statistics and how childbirth education can either help improve birth outcomes. This week we will cover epidurals.

Exploring Epidurals

Currently in the US, the rate of epidural use is 70-75%. Epidural is the most common and most effective form of anesthetic for pain relief during labor. Choosing to give birth with or without pain medication is a personal decision. Some women plan an epidural, some request it at some point in labor, and some decide to forgo it. All of these decisions are valid and education can help parents make informed decisions about their pain management choices and what options they have.

RELATED: Navigating Inductions: The Power of Childbirth Education

What Are the Benefits of an Epidural?

There are many benefits to receiving an epidural. This is a list compiled by Henci Goer, author of Labor Pain: What’s Your Best Strategy?: Get the Data. Make a Plan. Take Charge of Your Birth.

• Only strategy capable of completely relieving pain
• Allows women to be awake and aware during labor & birth process
• Permits rest and sleep
• Helps to be able to relax and enjoy the birth
• Anecdotally, they can sometimes put a stalled labor back on track

Epidurals can become necessary even for those who are planning an unmedicated birth. There can be benefits to receiving an epidural during labor besides pain management we typically think of. An epidural can be a good tool for a woman who has been awake for a long period of time and needs to rest. Often she can get a good nap, wake up, finish dilating and push out her baby. They can be helpful for someone who is having a hard time relaxing their body. An epidural can be a great tool to use for additional help.  An epidural can also be helpful for a woman whose blood pressure has been running high, an epidural can help lower her blood pressure without additional medications. These are a few ways epidurals can be a great asset in labor.

How is an Epidural Administered?

Understanding the process of the administration of an epidural is also important. Let’s break it down.

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• 1-2 bags of fluids are given intravenously. An epidural can cause a drop in blood pressure and the fluids help prevent or alleviate this.
• Blood pressure will be monitored closely by taking readings every few minutes.
• An oximeter will be placed to monitor the mother’s heart rate. 
• Electronic Fetal Monitoring will be used to monitor the baby’s heart rate and reaction to the medications. This is a belt that is placed near the bottom of the belly.
• A contraction monitor will also be used to monitor the frequency of the contractions. This belt is placed near the top of the belly. 
• A catheter will be placed to drain the bladder.
• The epidural is administered. A small catheter is placed in the back and then taped in place to the shoulder. 

RELATED: Do I Need a Birth Class if I’m Planning an Epidural?

What Are the Risks of an Epidural?

All pain management options have benefits and risks to weigh. While there are many benefits to an epidural, there are also risks associated with receiving one that should also be taken into consideration when planning how to manage pain in labor.

Henci Goer lists risks in her book as well which include:

• Changes how the birth is managed and ascribes to the medical model of childbirth
• There is a delay between request and relief
• Side effects including nausea/vomiting, spinal headache, headache, backache
• Cause low blood pressure
• Fever
• Can impede labor increasing the need for pitocin, instrumental delivery, and c-section
• Postpartum hemorrhage
• Interfere with normal labor hormones
• Lead to more babies with lower APGAR scores
• Effect breastfeeding
• Increase out-of-pocket costs

Managing Epidural Expectations

Everyone weighs risks and benefits differently but understanding the whole picture can help families confidently decide which route they want to take. 

It is also incredibly important to manage expectations when planning an epidural.  Will an epidural take all of the pain away? The good news is that epidurals work how the birthing person intended about 90% of the time! However, women also report experiencing epidurals in different ways. Some women experience “patchy” relief or relief only on one side. Some may feel pressure and equate that with pain when their expectation was to not feel anything. While we know that epidurals work the vast majority of the time, it is helpful to understand the variations reported and have other ways of helping with pain in the rare case it doesn’t work in the way that was expected. 

Ultimately we want birth to be a satisfying and powerful experience. Education is an important part of knowing what to expect so parents can decide if an epidural is the right form of pain relief for them. 

Do you want to help families make informed decisions to help them have an amazing birth?

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