At CWCC we truly respect differing opinions about childbirth preferences and our goal is to make your labor experience personal and aligned with your own beliefs as much as possible. But we hope that this article will dispel some common myths about childbirth and help you to be educated in your decision making, and not let decisions be based on non- scientific information.
It is not uncommon at an early pregnancy visit for a patient (especially with the first pregnancy) to express her ideas about how she wants her labor experience to be. One of our first responses to these ideas is always to ask her to understand that the labor process is dynamic and unpredictable, and while having wishes is human nature, labor is a unique time when we have to “go with the flow” and follow the course that the process takes us on, and trust that your provider has your best interests and those of your baby in mind with all of her decision making. Making firm decisions about what you want can lead to disappointment when things don’t go a planned or when the reality of the situation forces you to change your mind about something that you thought was set in stone.
For example, we discourage patients from saying “I am not getting an epidural, no matter what”, since if they have never experienced labor they may find that they are disappointed or embarrassed if their position changes. Similarly, thought processes starting with ideas like “I will be devastated if I have a C-section”, “I don’t want Pitocin no matter what” or “I don’t want to tear” are fraught with the possibility of emotional fall- out if our plan does not become a reality, and labor is a unique opportunity to relax and put your trust in our hands and recite that part of the Serenity Prayer which asks us to “accept the things I cannot change”.
For patients leaning towards a “natural” (unmedicated) childbirth, it is important to know that there is certainly some great wisdom in the natural childbirth literature, but we have found that there are also several common myths that are propagated in the community and online. Below we will go through the most common ones and add the scientific viewpoint for balance.
1. Epidurals are dangerous for the baby.
We are commonly told by patients that they don’t want an epidural for a variety of reasons such as that they increase the risk of C-section, are risky for the mother, or cause harm to the fetus.
Many studies have looked at the risk of C-section due to labor arrest with epidurals compared to labors without epidurals. The results of these studies have differed widely from a small increased risk, to no risk, to a small risk only if given too early in labor, to no risk even if given early in labor. Putting all these studies together it is clear that the effect is minimal at best, especially if the epidural is given when a patient is actually in labor (not in so called “latent labor” which is the period before true labor). Some studies and our own observations frequently show that the immediate relief of pain and relaxation that comes from epidural administration can actually speed up the labor process, and not infrequently a stalled natural labor can resolve right after the patient relaxes with her epidural in place.
The likelihood of C-section from fetal heart rate changes is also very rare as a result of an epidural. While occasionally maternal blood pressure can drop right after an epidural and this can temporarily affect the fetal heart rate, it can almost always be resolved with position change and this would be a very unusual reason to do a C-section.
Since millions of women have been getting epidurals around the world annually for many years, there is plenty of data on the risk of an epidural to the mother. The risk of any major complication from an epidural done by a professional anesthesiologist trained in obstetric anesthesia (as at Woman’s Hospital) is exceedingly low. Minor risks such as temporary sore spot or bruise at the point of placement, a headache, which can last for a few days, or lack of adequate pain control can occur in a small subset of patients but do not result in permanent harm. Serious problems such as death, permanent back pain or nerve damage are so rare that no patient in CWCC’s history has ever had such a problem.
Epidurals are absolutely not harmful for the baby. The beauty of an epidural is that the anesthetic drugs stay in the epidural space (a space surrounding the nerves that come from our spinal cord) and a negligible amount gets into the bloodstream (from where it could cross the placenta to the baby). This is why patients with an epidural feel mentally clear; they are not getting any drugs to their brain, nor is the baby. On the other hand IV medications do travel to the baby and make both the baby and mom quite sedated. Furthermore, IV pain medications just don’t work that well and make us drugged up and unable to participate in the labor process.
The bottom line is that we feel that epidurals for relieving the pain of labor are one of the best developments in women’s health ever made, and you would be hard pressed to find an obstetrician in the western world who volunteered to go through her own labor without one. One way of looking at it is that you get the same baby at the end, and there are no medals given for unnecessary suffering. But we respect each woman’s right to choose and will support you in an unmedicated birth if that is your choice, but do hope that this decision is not made due to misinformation about safety.
2. Pitocin is dangerous.
Pitocin is a medication which acts like our natural hormone oxytocin to stimulate contractions of the uterus. While like most things it can be dangerous if used irresponsibly, Pitocin is a wonderful and frequently lifesaving drug which allows us to start or speed up the labor process in cases that require the baby to be delivered for maternal or fetal health reasons, when labor progress has slowed or stopped, as well as in elective cases.
Very strict guidelines are in place at all modern hospitals (including our own) regarding the safe dosing of Pitocin. Since this drug makes the uterus contact, too much can cause contractions to be too strong and not give the fetus time to rest between contractions, and this could cause a lack of fetal oxygen over time. Even when given at the conservative recommended doses, patients on Pitocin have continuous fetal monitoring to make sure that any fetal heart rate changes are recognized immediately, and the Pitocin can be reduced or turned off. Pitocin is very short acting which is why a continuous drip is used, and also why turning it off results in almost an immediate reduction in contractions.
Pitocin saves lives in cases when induction of labor is necessary in cases of maternal high blood pressure, low amniotic fluid, fetal growth issues and a number of other obstetric complications. But more often Pitocin is used in a normal labor when the labor progress has significantly slowed or stopped. In these cases Pitocin is an alternative to C-section, and frequently gets labor going again in a patient who otherwise would have been headed to surgery. This is why we discourage patients from having their minds set on not getting Pitocin in labor. If one persisted in that point of view, in many cases your doctor would be forced to perform a potentially unnecessary C-section.
Sometimes patients choose to have their labor induced for social reasons, and this is a choice that we support if the pregnancy is at least 39 weeks and the cervix is ready. Sometimes the distance from the hospital, busy work or family schedules and other factors make this a good decision for a particular family and in these cases judicious use of Pitocin is similarly very safe.
3. Clamping the cord immediately is bad for the baby.
Many studies have been done on this issue and the data is pretty clear that in full term babies the timing of cord clamping makes very little difference. http://cwccblog.com/when-is-the-best-time-to-clamp-the-umbilical-cord/
4. Episiotomies are bad
There is no scientific evidence that a routine episiotomy is a good idea and your CWCC doctors do not do routine episiotomies. That being said, sometimes an episiotomy avoids much more major damage. The more babies you have had, the less likely it is that we will have to make a cut in the tissue to allow the baby to safely deliver. Most often the decision of whether or not to make a cut to assist the safe delivery of the baby occurs with the first pregnancy. In general, second and further deliveries are at low risk of a major tear and we usually allow the tissue to tear a little spontaneously if necessary and are less likely to make a cut.
At the moment at which the baby’s head is half way out, your doctor will make a quick decision about how likely the tissue is to have a significant and potentially harmful tear, and will sometimes cut a small episiotomy to avoid a major tear. A major tear may extend into the rectum or cause other serious damage and it is always our goal to avoid that.
If you have other questions about natural childbirth or labor myths, please talk to your provider!
Did you learn something from this post? If so let us know! What topics would you like to see discussed in future posts? Please send feedback regarding this post to firstname.lastname@example.org.
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