Get an intrathecal, not an epidural

This past Sunday I was visiting with a friend at church who is a midwife. We got talking about natural childbirth, which we are both pretty passionate about. Among other things, I mentioned my recent experience delivering an 11 lb. baby naturally, and how I'd heard that having an epidural actually makes it impossible to deliver big babies vaginally. She confirmed this. I then talked about how I'd requested an intrathecal (instead of an epidural) during my first labor, and now looking back I realize that if I had had an epidural, I would almost definitely have ended up with a C-section (baby was almost 9 lbs.); and I wondered why more doctors don't push intrathecals over epidurals.

Well for one, as this friend told me, epidurals are more expensive and so anesthesiologists get paid more for administering epidurals over intrathecals. According to her, intrathecals are considered "outmoded" by many doctors, and so are not even presented as an option anymore. The only way I personally came across this pain management option was that during my first pregnancy my midwives presented me with a book titled "While Waiting." Even in that book, all it really says about risks of intrathecal over epidural is that "Current research suggests that the incidence of need for forceps or vacuum extraction or Caesarean delivery is about the same for women receiving intrathecal anesthesia compared to those receiving a regular epidural."

So what's the difference? What initially attracted me to the intrathecal over the epidural (though I was planning on a natural delivery, I wanted to have an acceptable pain relief option available should I need it), was that the intrathecal is more likely to allow the woman to move around and aid in pushing. An intrathecal numbs the pain without affecting the muscles. The drawback? An intrathecal typically only lasts for 2-3 hours. For the woman who wants total pain relief during labor, obviously the intrathecal is not going to do it for her. But for the woman who is willing to labor naturally for as long as possible but wants to keep the option open for temporary pain relief through the most difficult part of labor (being transition and pushing), the intrathecal makes a whole lot more sense.

One drawback that epidurals are notable for is that they hinder the laboring woman's ability to feel and listen to her own body's cues to push. I knew this, and I wanted to avoid being tied to my bed during labor. I wanted to be an active participant in the birth of my child.

So why is the epidural, then, the "drug of choice" for pain management during labor? Even if women are aware of the choice to have an intrathecal, they might be dissuaded by their doctor by the fact that an intrathecal begins to wear off after a couple of hours. This fact is viewed as a bad thing by many laboring women, who have been conditioned to believe that all pain is bad and traumatic and should be avoided. I don't like pain; even mild discomfort tends to make me irritable. But I also have come to believe that all pain is not created equal. And in the case of childbirth, the pain which accompanies contracitons and pushing is good pain, productive pain. And with all three of my deliveries, I have strived to use my pain, to embrace it, to make it work for me. And I have been rewarded with three vaginal deliveries, two of which were completely medication free (aside from receiving antibiotics in early labor for Group B Strep). I won't say it was easy, as it was quite the opposite; but the reward-- for me-- was the avoidance of unnccessary C-secitons due to the inability to push out my big babies.

So where did the intrathecal come into play? During my first pregnancy, my baby was overdue. I requested to be induced. To make a long story short, being on-and-off the pitocin for 30+ hours and getting very little sleep in all that time, by the time I got to the transition stage of labor I was exhausted. Up to this point, I'd been managing my labor pain pretty well; but I can tell you after experiencing both, the pain of a natural contraciton versus the pain of an induced contraction are so very different. Chemically, I believe that when contracitons are induced, the body does not have the same embracive response as it would to natural labor contractions. Also, induced contractions follow a different "rhythm" than natural contractions, often occurring one on top of the other rather than being spaced out with natural rest periods in between.

So, I got to the point where I knew I needed to rest before I had to push my baby out. I got out of the tub and into the bed, and before long the anesthesiologist arrived to administer my medication. I shudder to think what might have transpired had I gone into labor with no birth plan and having done none of my own research on my pain management options. As it was, I had written into my birth plan to get the intrathecal, so that was what he was prepared to give me.

The relief was almost immediate. I slept for two blissful hours. I might have slept even longer, but I was suddenly awakened by my pain beginning to return, and I realized that I had an irresistible urge to start pushing. I pushed the call button and alerted the nurse, who in turn alerted my midwife. The nurse helped me through the first few pushes before the midwife got there. I pushed my baby out in about eleven minutes, which is-- statistically speaking-- quite fast for a first-time delivery.

My baby weighed in at 8 lbs. 15 ounces. A weight which-- if most doctors knew I was going to deliver such a big baby before the fact-- would have recommended me for an automatic C-section merely judging by my petite size (5 ft. 2"). It seems really silly to me now that this would be the case, considering I have managed to vaginally deliver a baby weighing over 11 lbs. 9 lbs in comparison seems absolutely tiny.

So what led to this erroneous wide-spread belief that big babies cannot be delivered vaginally? You can come to your own conclusions, but personally, I'll blame it on the epidural.

And what's the take-home message of the whole post? To sum it up: If you're going to use pain management to get through labor, please please please have a heart-to-heart with your doctor or midwife about trying the intrathecal. And refer them to this blog post. Because doctors and women need to become more educated on the subject of appropriate and effective pain management while still facillitating vaginal deliveries and decreasing the number of unneccessary C-sections.