With all the talk recently about epidurals, we would like to share with you where Lamaze childbirth educators stand — and what they teach — when it comes to epidural usage in labor.
What is Lamaze’s position on epidural use?
- Expectant mothers need balanced and accurate information about the risks and benefits of epidurals to determine the best choice for her and her baby.
- Mothers don’t need judgment – they need information. Women are not always told all of the risks associated with an epidural.
- Lamaze Certified Childbirth Educators provide the information moms need to make an educated decision.
What risks do epidurals pose to mothers and babies?
- Epidurals are associated with a number of risks, including:
- Prolonging labor
- Higher risk of fever and postpartum separation to rule out infection
- Increased risk of instrument delivery
- Increased perineal trauma
- Maternal hypotension, which can lead to worrying fetal heart rate changes
- Increased difficulty with breastfeeding
- If the mother opts to have an epidural, the timing is important. The early use of an epidural is associated with increased cesarean rates.
- Having an epidural inhibits the mother’s ability to move freely during labor – an important part of keeping labor moving smoothly.
When is an epidural medically necessary?
- Expectant mothers may need an epidural in certain situations:
- Labor is prolonged and difficult.
- The mother undergoes a cesarean.
- The mother has very high blood pressure.
What alternatives are there for coping with pain?
- Lamaze teaches coping techniques to help women cope with labor pain, including bathing and changing position.
- Continuous support from a partner, relative, friend or doula also can help women through contractions.
- It is important to remember labor pain is not a pathological pain, like the pain of a broken arm or illness. It is a natural part of the labor process and signals that the mother’s body is working as it should.
- Pain can actually help keep the birth process moving, triggering a cascade of hormones needed to keep labor active. It can also signal important things to the mother, such as the need to move and change positions to allow the baby to descend.
For additional information on epidural usage, check out the following links:
- Appropriate Use of Interventions: Epidural Analgesia and Anesthesia
- Epidurals: Food for Thought
- When Research is Flawed: Does the Timing of an Epidural Influence the Risk for C-Section?
- Healthy Birth Practice #4: Avoid Interventions That Are Not Medically Necessary
About Cara Terreri
Ask our resident obstetrical expert, Henci Goer, any question you have about conception, pregnancy, birth, and newborns. 
Thanks for posting this. I’m an LCCE and teach in a hospital. A lot of my students start the classes wanting an epidural and it’s interesting to listen to what they do and don’t know about the procedure. A woman who has been teaching much longer shared with me that they’re not really making a choice if they don’t understand all the possibilities – if they don’t understand what labor without an epidural would look like and they don’t really understand the impact of having an epidural, they aren’t really making a choice when they say that they are choosing an epidural.
What’s hard is the fear. You can feel it so strongly in some of the moms as they talk about being clear about wanting an epidural. So many have heard such nasty stories of birth without medication that they’re terrified and don’t trust their bodies at all. That’s where I put my teaching focus – providing information so they have what they need to truly choose and facilitating conversations in which they can really talk about the fears and hopefully move through them a little.
Another factor seems to be the perceived camps – medicated and unmedicated birth. When either side speaks with judgment and dogma or a sense of “better-than”, it creates deep divides that prevent true understanding from happening. I think some women hear the dogmatic language and think, “Well, I’m not a unshaven radical hippie and don’t want people to think I am, so I better choose the epidural” or “Well, I don’t want to be seen as not a strong woman or someone who doesn’t care about the health of her baby, so I better choose unmedicated.” This is where I see our role as LCCEs as critical – providing truly non-judgmental information that creates the space for the women to make whatever informed choice is best for them.
I’m an LCCE as well, although I’m independent.
Anna is right on many levels. Facilitating that choice is key for a Lamaze instructor. She is also right on the “natural” birth vs. medicated or managed birth. I see it all the time. I do my best to fit in the middle, to help women find what works for them, rather than what worked for their friends.
One other thing to add. Much of the time the additional interventions are not discussed when talking about the epidural. I had a student recently who was shocked when I told her she’s receive a urinary catheter if she choose an epidural. She told me right then, that she’d have to reconsider her choice because she “can’t stand catheters”. Giving FULL disclosure is important.
Anna — thanks for your input and thoughts. I think you said it best with, “…providing information so they have what they need to truly choose…” This is why quality childbirth education is so important — even (or especially) for women who say “I know I’m going to get an epidural, so why do I need a childbirth class?” Knowledge is key.
Deena — Great point about full disclosure. Many interventions come with additional interventions or “accessories” that have their own set of discomforts and/or risks.
The article started so well: “Mothers don’t need judgment – they need information.” But then it went downhill, starting with this statement: “Women are not always told all of the risks associated with an epidural.” The fact is, women are misinformed about the risks of epidural, and this article is not an exception. Let’s take the statements of risks of epidurals that follow.
Prolonging labor. According to the Cochrane review, epidural prolongs the second stage of labor by approximately 15 minutes. This is insignificant. Moreover, many studies demonstrate in fact faster progress and shorter duration of labor.
Higher risk of fever and postpartum separation to rule out infection. There are other risk factors for developing fever, most important being primiparity and the duration of the first stage of labor.
Increased risk of instrument delivery. That is true. However, the use of forceps is not due to distocia (obstructed labor) and the use of forceps in the context of epidural is not associated with the increased risk of tears.
Increased perineal trauma. This is not true. Perineal trauma is associated with prolonged and/or obstructed labor. Incidentally, women who have such labors are more likely to request and receive epidural. It is important to understand that the association between the two does not mean that one causes the other.
Maternal hypotension, which can lead to worrying fetal heart rate changes. Rare with the use of modern epidural techniques, which includes the use of very low concentration of local anesthetics.
Increased difficulty with breastfeeding. Once again, this is misinformation. Properly conducted trials fail to demonstrate this.
If the mother opts to have an epidural, the timing is important. The early use of an epidural is associated with increased cesarean rates. Wrong again. Epidural started early does not increase the risk of caesarean
Having an epidural inhibits the mother’s ability to move freely during labor – an important part of keeping labor moving smoothly. Women with epidurals are encouraged to stay in bed. However, as mentioned earlier, the duration of labor is minimally (if at all) affected by epidural.
Epidural is indicated when the woman decides she wants one. IN the absence of contra-indications the woman’s wish is the legal requirement to provide one.
All of my statements in this post are supported by medical literature. All the references are on my website, which is free and fully open to the public.