natural vs epidural

Risks and benefits of an epidural versus a natural non-medicated childbirthWhen a woman is pregnant, it is very important for her to investigate what pain management she would like to use when she goes into labor so figuring out a birth plan can be useful. Even if she doesn’t follow it, knowing the risks and benefits of certain medicated and non-medicated methods beforehand with a clear mind will aid in the best judgment for her and her unborn baby. Childbirth is a painful process so an epidural is a good method for pain management as it is a simple procedure to get done, the benefits outweigh the risks and there is not as much pain verses if you had a natural non-medicated childbirth. The key is to understand what an epidural is, the process and what it does. She should look at the risks and benefits of an epidural and its effects on the pregnant woman and her baby. While there are other expectant mothers who chose non-medicated pain management throughout their labor, psychologically it doesn’t make you less of a person if you get medication to help you with the pain; everyone has different pain tolerance levels. In this paper I will discuss the process of an epidural, the risks and benefits of an epidural, and having a natural birth with no medical interventions. An epidural: what it is, the process and functionMany women are unsure what an epidural does, as there is a lack of understanding with provisional of antenatal education, women tend to be misinformed; having healthcare providers up to date on information is key. In addition, have the health care providers take the time to discuss the topic with only information based on facts (See Figure 1) (Cutajar & Cyna, 2018). An epidural is a slower onset of a central sensory nerve blockade not only the nerve roots in the epidural space but also blocking the nerves from transmitting pain to the sympathetic nerve fibers that travel together (Anim-Somuah, Smyth, Cyna & Cuthbert, 2018). The procedure is common, the patient is sitting up hunched over in a C-shape position, then a needle goes through and punctures the dura-arachnoid membrane and enters the subarachnoid space (lower lumbar area) (Chau & Tsen, 2018). A catheter is then inserted through the epidural needle, which the needle will be removed while the catheter stays to deliver local anesthetic (usually bupivacaine) and an opioid (generally fentanyl or sufentanil) medications into the epidural space to provide ongoing analgesia (See Figure 2) (French, Cong & Chung, 2016). A misconception is that an epidural is painful to get, where in fact, sitting completely still while having contractions are more painful than the procedure itself. Depending on a woman’s pain level, she can use intermittent manual top-ups by a Patient-Controlled Epidural Analgesia machine (PCEA), just by pushing a button that the nurse or doctor provides them (Chau & Tsen, 2018).Risks and Benefits of an epidural affecting mother and babyThere are very few risks associated with an epidural. A woman who is concerned about breastfeeding, no significant differences were found when initial timing of the lactation rate, however, the epidural group showed shorter starting time of lactation, larger milk secretion and higher prolactin levels 48 hours postpartum (French, Cong & Chung, 2016). After giving birth the mother can often be tired, but the numbing effect of the epidural can keep pain under control and the woman reported a better postpartum mental state (French, Cong & Chung, 2016). This is because the woman can relax and get much-needed rest during labor. The side effects the mother can experience are a fever, shivering, a ringing of the ears, backache, soreness where the needle was inserted, nausea, or difficulty urinating are all common. A woman will require assistance when walking due to the lower half of her body may feel numb. Complication affecting the mother can consist of post-dural puncture headaches as a result of a leak of cerebrospinal fluid into the bloodstream, uterine tachysystole (which is excessive frequent uterine contractions) due to the use of injecting opioids into the intrathecal space (Chau & Tsen, 2018). Where the catheter of the epidural was inserted there may be a risk of permanent nerve damage. As for the fetus, complications can arise from the medications reaching through the bloodstream, therefore any medication used during labour can affect both in-utero and ex-utero. In addition, there can be a decreased placental blood flow leading to fetal bradycardia due to intrathecal opioids that were used with the epidural (Chau & Tsen, 2018). The complication rates of an epidural are low, but do happen, that is why women need to have the proper and correct information while pregnant so they can make an educated decision. Natural Birth with non-medical interventionsA final concern for some women is the assumption that a woman’s body knows how to birth with minimal intervention and that pain is an essential part of birth; allowing the process to happen at its own pace (Preis & Benyamini, 2017). That is untrue, as labour and delivery can be a complex process and unexpected situations can arise. Woman are often thought to be stronger if they choose a natural birth; this is based on the basic belief system about the natural birthing process and how closely it is linked with the woman’s cultural belief system (Preis, Gozlan, Dan & Benyamini, 2018). Some non-medical interventions can consist of breathing and relaxation techniques, massage, hot/cold therapy and a water birth. Women who chose to have a natural birth state they do not fear the process itself, they are usually educated in the birthing process and often consider birth as a natural, non-medical process; changing a woman’s opinion would be difficult to do as it is considered to strengthen the belief in themselves and having a natural process of birth will improve the experience as a whole (Preis, Gozlan, Dan & Benyamini, 2018). When women chose a natural birth, it is highly influenced by the obstetric history of her midwife and are entrusting that she knows best as a medical professional. Woman who desire having a natural birth are faced with a medical system that does not encourage or support it, as there are reports of higher then normal maternal and infant mortality and morbidity rates when a woman chooses a natural or home birth (Preis & Benyamini, 2017). It can come down to woman are only concerned about their needs and not their unborn babies’ safety. In recent years many women turn to fertility treatments to become pregnant and have a greater chance of having a high-risk pregnancy making a natural birth a risky situation. With an epidural it allows the body to be in a relaxed state, and the woman can enjoy the birth process.Conclusion In the end the final decision is up to the mother and what she wants to do; if there is not an emergency or harm to the unborn baby. Pain is perceived individually and can be different for each woman. From my experience with having done both ways, with my first, I was terrified of an epidural as I was not well educated on what it was, no one explained the procedure to me, so I went ‘superwoman’ and did it naturally with non-medicated methods. Then with my fifth, I went naturally as he was a stillborn baby and for personal reasons, I wanted my body to be in as much pain as my mind was. For my second to fourth and the sixth to eighth pregnancy the epidural was always the way to go. As even though I do have a high pain tolerance I just wanted to enjoy the birthing process. I was lacking sleep already and giving birth is an exhausting procedure, I wanted and needed the rest. I wasn’t sure on the exact procedure, I never knew the risks and complications that I was potentially taking. It could have been a very serious outcome, you could be paralyzed if the anesthesiologist did something wrong. In the end, woman must understand their basic cultural beliefs and psychological factors pertaining to childbirth. Some people presume the epidural disempowers woman; however, that is not the case, it empowers them in their mind, body and soul, it allows the woman to embrace a choice and experience birth with minimal amount of pain while enjoying the birthing process – the miracle of life.