We’ve all seen the movies where a woman’s water breaks and is frantically rushed to the hospital.
Everything happens so quickly and suddenly. The woman is clearly in huge amounts of pain but
a few pushes and a fainting side character later, the baby is born.
While this course of events is entertaining, these dramatizations aren’t necessarily accurate.
First off, childbirth isn’t typically this unexpected.
While babies can come prematurely, there are still signs;
your water breaking tends to occur DURING labour not as the first sign.
During the process, women are often presented with
the option of getting an epidural to ease the pain.
However, this treatment is not without myths and controversy.
One such myth is that taking an epidural can
increase the likelihood of needing an unplanned or emergency c-section.
There is a culture around pain being a right of passage in childbirth. Many people say that
the pain is necessary for “preparing a mother for the responsibility of nurturing a newborn baby."
However, there is no evidence that pain during
childbirth is associated with better outcomes for the baby.
Some women see the pain as "worth it"
but there are options to help mitigate the pain associated with childbirth.
Epidurals are a way to block pain signals, from the lumbar region,
from being sent to the brain. If your brain doesn’t get the
message, you won’t experience the pain. A small amount of anaesthetic is injected,
using a catheter, into the epidural space in the spine to numb the nerves.
The goal is to block the pain from the lower
half of the body so the woman can deliver her baby more comfortably.
At the low dose, women can still move their legs and walk around.
Epidurals have been in use since the very early 1900s.
In 1989, four researchers published a research study
that sparked the advent of the epidural c-section debate.
The study concluded that epidurals increase the likelihood of needing a c-section.
At the time that this study came out, epidurals had become incredibly popular for use.
However, this study began the debate on whether epidurals should or should not be used.
Since then, these researchers have published multiple other
studies that support their position.
However, there have been countless other studies conducted by other researchers
that were unable to find the same results as Thorp and his colleagues.
This overwhelming majority has concluded that epidurals do not in fact cause c-sections.
That said, there must be other factors at play for
why the researchers found the results that they did.
One of the most important factors was that the researchers were conducting
observational studies which are known to be prone to bias.
These studies compared women who were given epidurals to those who weren’t.
However, this is far from a fair comparison,
as women who receive epidurals report higher levels of pain and experience tougher labour.
Observational bias is not the only factor that contributes to these false results.
These other factors can be explained by looking at the findings of a Study conducted at Tripley Army
Medical Center ー a military hospital in Hawaii. The study found that before 1993, less than
1% of women at this military hospital received epidurals.
Then in 1993, a rule was passed that made it compulsory for all
military hospitals to offer epidurals on demand.
During that year, the rate of epidural usage went from less than 1% all the way to 80%.
So why is this study relevant to the epidural myth?
Well, if epidurals do in fact lead to c-sections then we should see an
increase in the c-section rate at this military hospital after 1993.
However, the results showed that the c-section rate remained relatively constant.
Before 1993, the rate was 19% and after 1993 it was 19.4%, a very minimal difference.
This study revealed that the likelihood of women receiving c-sections
depends more heavily on how hospitals deal with tough labours with long pushing times.
If an individual is concerned about receiving a c-section,
it is highly suggested to look into the c-section rates of local hospitals as they tend to vary.
In fact, c-section rates in the United States can vary from 7% to 70% between different hospitals.
So, if there is so much evidence that epidurals do not cause c-sections,
then why does this myth prevail in our society?
The first reason is that there are still a handful of healthcare professionals
who believe that epidurals lead to c-sections.
This belief is usually held by individuals who also advocate for natural birth,
which would not include using epidurals unless medically necessary.
Since midwives tend to be the largest advocates for natural births,
they are also more likely to advocate against the use of epidurals. That said,
it is not surprising that a study found midwives were more likely to believe that epidurals lead to
c-sections than other medical professionals, such as family physicians and obstetricians.
This leads to the second reason why this myth remains in society. People tend to look for
proof that supports their pre-existing bias. So someone who already has a bias towards
not using epidurals will be more likely to believe the studies supporting their position
rather than consider the countless studies that oppose their bias.
The initial studies opposing epidurals and linking them to c-sections
were published over 30 years ago. Since then, there have been important
modifications made to epidurals. Now, individuals are given a much
lower dose to start with and have control over when they want more.
There are several benefits of using epidurals during pregnancy.
On average, an epidural can relieve pain in 10-20 minutes.
The vast majority of women experience little or no pain throughout labour and delivery.
Epidurals also assist women in staying alert, enjoying,
and actively participating in the childbirth process.
They let you relax more easily, which is useful during lengthy periods of labour.
A more positive delivery experience is achieved through relaxing and avoiding discomfort.
Finally, epidurals may aid in the treatment of postpartum depression (PPD).
Although epidurals offer many advantages, there is also the potential for negative effects.
These symptoms include shivering, fever,
and itching. There is also a chance that it can lead to a low blood pressure.
People who have had an epidural removed may feel nauseous, disoriented,
and/or experience back pain or soreness at the injection site.
Additionally, severe headaches may occur but this is an uncommon side effect
experienced by only 1% of people.
All-in-all, epidurals are commonly used during childbirth and their popularity is increasing.
In Canada about 60% of births every year involve the use of an epidural block.
There are pros and cons to the treatment but
ultimately whether a woman chooses to have one or not is entirely her choice.
If you would like to explore alternative options for reducing the pain,
it is best to speak to an obstetrician or a midwife to get the most accurate options for you.
At the end of the day, there is no one “right” way to give birth,
nor do you need to feel pain to form a connection with your baby.
When it’s all said and done, the goal is to have a healthy mother and newborn.