Unmedicated birth—what’s all the hype?
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If you start researching unmedicated births, you’ll quickly see there are some very strong opinions on the topic. The evidence on advantages of unmedicated births is compelling enough that my husband and I want unmedicated births for our children. And after having a successful unmedicated birth with Miss F (you can read more about that here), I can truly say that it was an incredible, empowering experience that I want all my friends to have! But that being said, medical studies show us that outcomes between medicated and unmedicated births just really aren’t all that different.
The short summary of why you may want to choose an unmedicated birth is that medical evidence points to the fact that it slightly decreases the risk of more intense interventions, such as a c-section, it may slightly decrease the length of labor, and that it generally leads to an easier recovery for the mother. Many proponents of unmedicated birth talk also about more alert babies and higher nursing success rates, but the stats at this time just doesn’t back that up (although anecdotal evidence might).
Side note: for the purpose of this discussion, when I’m talking about an unmedicated birth, I’m specifically talking about a birth without pain medication like an epidural. I consider medical induction to be in a different category, and the decision whether or not to be induced is completely separate from whether or not to have pain medication and should be considered carefully with your medical provider.
Before we dive in further, it’s helpful to understand the science of an epidural, and how it interacts with a laboring mom’s body. A needle is used to insert a catheter into the spinal canal, which is the small “tube” filled with cerebrospinal fluid (CSF) that the spinal cord runs through within the vertebrae. Numbing medication can then be fed into the catheter for the remainder of labor and partially or completely reduces sensation anywhere below where the catheter was placed, ideally reducing or completely eliminating the discomfort of contractions while still allowing the mom to maintain some muscle control. Although somewhat controversial, it is generally accepted that a small amount of the medication does cross the placenta to the baby.
Let’s start by laying out all the ways an epidural might negatively affect labor. I hesitated including all of this because it makes an epidural sound very, very scary, but keep in mind that while these side effects are all possible, medical studies just don’t show evidence that birth outcomes are affected.
Epidurals commonly cause a drop in maternal blood pressure, which can also cause a drop in the baby’s heart rate. IV fluid is administered preemptively to combat this. This ties a laboring mom to an IV, restricting movement (which can slow down labor).
The fluids don’t always prevent the drop in blood pressure, so sometimes additional medication has to be administered to increase the mom’s blood pressure.
It is not uncommon for women to have reactions to the epidural, which can include uncontrolled shaking (exhausting to a body that is already working so hard), nausea, and even running a low fever (more on this later).
The numbing effect of an epidural varies by woman (and how effectively the epidural is administered), so a woman may be confined to her bed once she receives it. Laying in bed can slow labor.
The relaxing effect of an epidural and being confined to a bed can stall labor, requiring Pitocin (induction medication) to be administered. Pitocin causes more intense and closely-spaced contractions; if the epidural is working the mom won’t feel their full effect, but her muscles will be working just as hard.
Some believe that a small amount of the epidural does cross the placenta to the baby. This may make the baby more sluggish, so he or she is less active in positioning him- or herself for birth, intensifying and lengthening labor even more.
If the Pitocin is effective, the woman will reach full dilation, but her body will be exhausted from the long and intense contractions and she still has to push out the baby. She may not be able to feel the contractions well, so her medical team may have to coach her when to push, which is less effective than pushing with her body. This lengthens the pushing stage and causes even more exhaustion and potential distress to the baby.
Ultimately, odds are higher that the mom will need an assisted delivery because she just won’t have the strength or coordination to push her baby out on her own. This could include an episiotomy, use of vacuum or forceps, or even a c-section.
Post-birth, the newborn may be more sluggish due to the small amount of the epidural that crossed the placenta. He or she may have a lower APGAR score, leading to the baby being whisked away from the mother to run medical tests. The baby also may be so drowsy he or she may not nurse well right away, which can lead to breastfeeding difficulties.
If the mother did run a fever from the epidural, the baby will be administered antibiotics. Even though an epidural fever would not cause harm to a baby, doctors have no way of knowing whether the mom’s fever was from the epidural or an infection, so they wisely play it safe. Antibiotics can wreak havoc on a newborn’s GI system, killing all the good bacteria he or she was colonized with in utero and during birth. If the baby’s gut microbiome is not intentionally rebuilt, this can cause lifelong GI issues.
Depending on how long the epidural takes to wear off, the mother may be confined to bed or a wheelchair for hours. She also may need to be catheterized if she cannot control her bladder.
For a small number of women, the epidural also causes a cerebrospinal fluid (CSF) leak. Sometimes the leaks can cause spinal headaches, because the brain, which is typically suspended in the fluid, begins to sag in the skull. While the leak usually resolves on its own after several weeks of rest and restricted activity, more severe cases will require a blood graft on the spinal column. (Note: while this is rare, I actually know two women who have experienced it severely).
Whew, are you feeling as overwhelmed as me after reading that? Take a deep breath, because as I mentioned before, the actual medical studies show us the effects of an epidural just aren’t that bad.
One of my favorite books, Expecting Better, has a fantastic chapter examining the actual proven impact of getting an epidural. While I’d love to share everything from this chapter, I would never want to plagiarize, so I encourage you to read it yourself. To sum up the author’s findings, though, the biggest impact is that an epidural typically causes a slightly longer and more difficult recovery for the mother. Thus, getting an epidural is a tradeoff–would you rather have a less intense labor or an easier recovery? Note that this isn’t to say you wouldn’t experience any of the other side effects of an epidural listed previously–those all do happen–but the statistics tell us that the outcome of your experience likely won’t be that different had you not received an epidural.
I want to touch on one final closing thought. Many women have the perspective that if they have a high pain tolerance they’ll be able to have an unmedicated birth, and if they don’t it’s not even worth a try. After a lot of reading and hearing countless birth stories, though, I just don’t think this is true. Ultimately I think the bigger factors are how your body is specifically built and how your baby is positioned in your body. I’m sure medical folk will tell you a number of other factors too, but in my opinion, pain tolerance just isn’t a great marker for whether or not an unmedicated birth will work out. Sometimes very athletic women need epidurals to relax enough to let their bodies dilate–their muscles are so strong and well-trained that they tense up too much during contractions. Other women have longer labors for a variety of factors, and getting an epidural actually allows them to rest enough to be able to effectively push and avoid a c-section.
To sum it all up, I personally loved the unmedicated birth experience with Miss F and plan to set this goal for future births as well. That being said, there is no “right” way to give birth, and every family should weigh the various options to make their own choice. And keep in mind–you can never predict how labor will actually go! So set those goals but hold them with open hands, constantly reminding yourself that the number one goal is getting your baby earthside in the safest way possible–all other goals pale in comparison. If you are considering an unmedicated birth, you may find it helpful to read Miss F’s birth story or check out my labor cheat sheet for your birth partner.