Back Up Plan

An epidural is an elective procedure

You don't have to have one, and there is no guarantee you will get one. I always recommend that expectant moms take a natural childbirth class, even if they want an epidural the minute they are in labor.

This is not just because there are advantages to natural childbirth. But, realistically, you may not get an epidural or if you do it may not work for various, often completely unknown reasons. Your birth plan may not go exactly the way you hoped and there are lots of factors that come into play. You know what they say about the best laid plans... Flexibility is essential. If someone is promising you a "pain free birth" they are not being honest.

A few possible scenarios:

• You come in to the hospital in full-blown labor, almost completely dilated and there is no time for an epidural (this might be a very GOOD thing if it’s not TOO fast).

• The L & D unit is completely crazy with high-risk moms needing emergency c-section, hemorrhaging, blood pressure is out of control or other problems and all available anesthesiologists are occupied with higher-needs cases.When you’re laboring, wanting an epidural, this is not what you want to hear (that you are not # 1) but, the staff must triage according to seriousness and the “normal” laboring mom may have to go it alone for a while.You’ll be very glad you learned some natural childbirth techniques such as breathing exercises, visualization and self-hypnosis which not only help with the discomfort but give you a sense of control in the situation.(One clue that your hospital may be having one of “those days” is if you have to call back several times to get in for an elective induction – electives are low on the totem pole and get in on a space-available basis.)

• You may deliver in a place that does not have a qualified practitioner to place and monitor an epidural or the equipment required such as oxygen, IVs emergency resuscitation medications, airways, a qualified provider who can manage emergencies if they should occur since regional anesthesia is not without risk.Location problems could even be due to emergencies, natural disasters, inability to make it to a facility that can accommodate this, or just due to limitations in small, rural community health centers.In a pandemic outbreak, mothers should not deliver in hospitals where there is massive infection such as influenza going on.In such circumstances (or in hurricane-torn areas, etc.) laboring women could be shuffled to midrange care facilities for their own safety but they may not have all the conveniences they would desire.Remember, ultimately it’s a safe delivery that is most important; not the epidural itself.

• Your body does not respond to the epidural. I experienced this first-hand with my last child. One half of my body was numb; the other half felt every contraction. Being only half in pain does not mean “half the pain” - this was not an improvement over the natural deliveries I had previously experienced. A non-working epidural also occurred with two of my daughters so this is not just a rare event (maybe hereditary?). You’ll probably hear friends’ stories about such experiences too. I suspect veteran moms sometimes like to frighten first-timers:)

• You could have a condition for which epidural anesthesia is contraindicated.A back or spinal cord injury could prevent this choice, depending on the severity of the injury.Active maternal hemorrhage, very low blood pressure, septicemia, infection near the placement area of the catheter, or a clotting condition (possibly even use of anticoagulation therapy for blood clots).

So, what about the back up plan?

There are several alternatives and methods for prepared childbirth such as Lamaze, Bradley, Hypnobirthing, etc. Your hospital prenatal class schedule probably includes some training in unmedicated childbirth preparation, but if you really want to master it and would like a more natural birth, I would advise you to take a class that has several sessions and focuses on the specific technique you desire. There are many similarities in methods but you may like the features of Bradley or Lamaze (or something else). This class may also be offered by your hospital so that's a good place to begin. If they don't offer it, they may have lists of practitioners who teach classes. Otherwise, you can google "childbirth educators," "natural childbirth" or "lamaze" along with the state and find a listing.

About.com's Robin Elyse Weiss, LCCE says:

"Studies have shown that taking childbirth classes can reduce the amount of stress in labor, which is the goal of all childbirth classes and the use of medication. By using other techniques to help you through labor you can have a more relaxing experience until the point at which you decide medication is the right option for you. Or you can simply choose to not use medications, as some women find labor to be much easier than they had anticipated.

.... In choosing a childbirth class, find one that really teaches viable alternatives to the epidural, not one that merely gives lip service to relaxation. Ensure that the instructor covers medications in labor, there are also other choices besides the epidural. Talk to the instructor and ask her about the outcomes in her classes, ideally you'll find a good mix of unmedicated and medicated births. If her outcomes go drastically in one way or the other, it might indicate she doesn't offer as much of one in the class. If you're concerned ask her. Tell her what you're looking for. You can even ask to speak to other people who've had her class. Check her affiliations. Is she a member of an organization that promotes freedom of choice in birth practices? Basically do your homework and make sure she is not affiliated with anyone who would influence her instruction. (This can include some hospital classes.)"

Hip Chic Pregnancy also has a listing of natural childbirth books. You can read about various methods and see what sounds right for you.

For a graphic video of an epidural placement, go here. Baby Center has other interesting childbirth videos, including natural birth on this site as well.