Improving your epidural birth

November 18, 2010 at 8:46 am

Back in August, a close friend from college specifically requested that I do some posts for women like her who plan to have epidurals. So I wrote the first in a supposed series of “Improving your epidural birth” posts, encouraging pregnant women to “hire wisely” when choosing a care provider.

This morning I got feeling bad that I haven’t written any more posts for that series, and I suddenly realized that I have! In fact, the vast majority of the posts I’ve written over the last six months are on topics that would be of interest to all women, not just those who choose to forgo pharmaceutical pain relief in childbirth. And scanning three+ years of posts on my old blog brought up many more.

So, with all of that in mind, I give you some of my best tips for improving your epidural birth (besides carefully choosing a care provider), gleaned from my blog (and other helpful sites) over the years.

1) Prepare your body for pregnancy.

The more I learn, the more I realize that the groundwork for a really wonderful birth experience must be laid long before labor begins. When you nourish and take care of yourself, your body will be stronger and better able to perform its vital functions in pregnancy and childbirth. A strong, healthy body is much less likely to suffer complications that can have a detrimental and traumatic impact on your birth experience.

Many of the same things that will best prepare your body for a healthy pregnancy will also improve your chances of conceiving—eating a diet rich in fruits and vegetables and low on processed foods, maintaining a healthy weight, optimizing your body’s levels of key nutrients (vitamin d, magnesium, essential fatty acids, and folate).  Making these dietary and lifestyle changes habits before conception will make them much easier to maintain throughout the coming pregnancy and beyond.  Check out these posts to learn more:

2) Exercise!

I began doing some research on prenatal exercise a couple of years ago, and the benefits I discovered in my reading absolutely blew me away. Women who continue exercising moderately throughout their pregnancies (three times a week for at least 20 minutes at a moderately hard to hard level of exertion) can expect to experience the following…

    * 75% decrease in the incidence of maternal exhaustion
    * 50% decrease in the need to artificially rupture membranes
    * 50% decrease in the need to induce or augment labor with pitocin
    * 50% decrease in the need to intervene because of abnormalities in the fetal heart rate
    * 55% decrease in the need for episiotomy
    * 75% decrease in the need for operative intervention (forceps or cesarean section)

Exercising women are also more likely to deliver before their due date (but not preterm), experience faster labors, and have reduced incidence of fetal distress. All of this data and more can be found in Dr. James F. Clapp’s Exercising Through Your Pregnancy. Because of what I learned in this book and other research, I made exercise a priority in my third pregnancy and now in my fourth as well (though I need to do much better than I have been!). My third birth was definitely my fastest and easiest. Check out these posts for more motivation:

3) Take steps to reduce your risks.

Sometimes pregnancy and birth complications arise without warning, but there are usually ways we can minimize our potential risks. Many of the most helpful risk-reduction steps involve good nutrition and exercise (which I’ve already mentioned above), but the following are some posts with more specific details about ways you may be able to avoid some of the most common pregnancy and birth difficulties:

4) Consider bringing along a doula.

It’s a common misconception that doulas only attend births for women who don’t want epidurals.  In fact, a doula’s presence can be a huge asset to any and all laboring women.  Just today I read a news story that reminded me again why doulas can be so helpful. According to an analysis by the Department of Health and Human Services, adverse events and errors occurring during hospitalizations account for approximately 180,000 deaths per year. In response to these findings, CNN’s medical blogger, John Bonifield, encourages those who are admitted to hospitals: “Bring someone with you to the hospital. Having an advocate at your side . . . can help insure that your concerns won’t go unheard during a hospital stay” (source). A doula can be just such an advocate, particularly because they are often already familiar with hospital policies and routine procedures and can help you avoid potential pitfalls.

Doulas can also help you avoid difficult deliveries. Gathering and analyzing the results of 15 studies, a team of researchers found that, compared to women laboring without a doula, women who labored with a doula were:

• 26% less likely to have a cesarean section
• 41% less likely to have a vacuum extractor or forceps delivery
• 33% less likely to rate their birth experience negatively
(Hodnett E, Gates S, Hofmeyr G, Sakala C. Continuous support for women during childbirth. The Cochrane Database of Systematic Reviews 2003. Issue 3. See DONA)

Other benefits associated with doula-attended births:

* Decreased newborn admissions to NICU
* Decreased infant health problems
* Increased mother/infant bonding
* Decreased postpartum depression
* Increased success in breastfeeding

And, I should add, sometimes epidurals just don’t work (or only work on one half of a woman’s body). For some women, even early labor is killer. So it’s a good idea to have someone present who is trained to help you cope with labor pain (even if you plan to get an epidural).  If you don’t feel comfortable hiring a doula, an experienced and comforting friend or family member can provide much the same benefit.

Here are some posts you might want to check out:

5) Let labor begin on its own.

While many women and babies weather labor inductions without any difficulties or regrets, induction is not without its risks.  The drug most often used to induce labor is Pitocin (a synthetic form of the hormone your body naturally produces to produce labor contractions, oxytocin).  Pitocin has not been approved by the FDA for inducing (or speeding-up) labor for doctor or patient convenience.  It is only meant to be used when absolutely medically necessary.  Roberto Caldreyo-Barcia, MD, former president of the International Federation of Obstetricians and Gynecologists, has said, “Pitocin is the most abused drug in the world today.”  Because of this Pitocin abuse problem (one hospital administrator admitted, “Pitocin is used like candy in the OB world”), many hospitals are implementing policies to reduce medically-unnecessary inductions.

How will avoiding Pitocin/induction improve your birth experience?

  • Pitocin generally produces contractions that are much longer, more intense, and more painful than normal contractions.
  • The intense contractions caused by Pitocin can abnormally restrict oxygen supply to the fetus.
  • This decrease in oxygen can lead to fetal distress and, when prolonged, emergency C-section.  Research has shown a definite increased risk of cesarean birth following labor induction.
  • Pitocin has the potential of causing tetanic contractions—contractions coming so frequently that they merge into one sustained contraction—which can result in premature separation of the placenta, uterine rupture, cervical tearing, excessive bleeding postpartum, as well as severely restricting oxygen supply to the fetus. Some of these complications are potentially fatal to mother and/or fetus.
  • Even without tetanic contractions, Pitocin induction leads to a higher incidence of postpartum hemorrhage as well as a higher incidence of neonatal jaundice.

There is still so much we don’t know about the possible long-term effects of neonatal exposure to synthetic oxytocin.  Some researchers believe that prolonged neonatal exposure to Pitocin, particularly when combined with fetal distress, can have devastating consequences for an infant’s oxytocin system.  This is particularly troubling considering that our oxytocin systems are crucial to the formation of loving bonds, social interaction, and stress reduction.  (I’m personally convinced that the Pitocin I was administered (probably out of hospital routine) following my oldest daughter’s birth interfered with our bonding process.)

This is one topic I could babble endlessly about, but I’ll stop there.  For more information about the benefits of avoiding Pitocin and induction, see the following:

6. Some more scattered tips…

  • Turn the lights off (or keep the lighting as low as possible) while you’re in labor.  Darkness facilitates the release of melatonin which can facilitate the labor process.  See:  Melatonin’s role in labor progress.
  • Stay out of bed, upright, and mobile during as much of your labor as possible, and avoid going to the hospital too early. Also delay requesting an epidural for as long as you can (sometimes epidurals slow labor down).  It’s a good idea to use gravity to increase labor progress for as long as you’re able to stay mobile.  See: Going To Hospital Too Early Increases Risk of Having C-Section (from ABC News) and Tips for Maintaining Freedom of Movement (from Lamaze).
  • Think twice (or three or four times) before consenting to a possibly unnecessary cesarean.  Being born through an abdominal incision bypasses some really important processes that can have long-term negative health implications for your baby.  See:  Bugs and guts.
  • If possible, let your epidural “wear-off” for the pushing stage so you can be in better control of what’s happening and more easily get your body into a more effective birthing posture. See: Birth in the standing position.
  • Request to have your baby placed immediately on your chest (skin-to-skin), breastfeed soon after delivery, and delay your baby’s first bath as long as possible.  All these things will maximize the oxytocin rush designed to occur at the time of birth and immediately following delivery.  I’m totally convinced that smelling your freshly-born unwashed baby for an extended period of time will enhance the bonding process significantly.  See:  On loving baby slime.

Do you have any other helpful tips to share with moms having epidurals?