Epidurals in Birth: Understanding What the Whole Story
Updated: Sep 8
During pregnancy, we think carefully about what we put into our bodies.
We choose nourishing foods. We think about getting enough protein, healthy fats, vitamins, minerals, and other nutrients because we understand that what supports us also supports our growing baby.
Medication can be a different conversation.
Some medications are important and necessary during pregnancy. For example, someone with low thyroid function may need thyroid medication to support their own health and their baby's development. There are times when medication is absolutely the right choice.
At the same time, many parents want to understand the potential effects of medications before choosing them during pregnancy and birth.
Birth is no different.
One of the most common medications used during labor is Pitocin. A synthetic version of your own natural hormone called Oxytocin. Both Pitocin and oxytocin cause the uterus muscles to contract. These contractions draw the muscle fibers up or shorten them causing the cervix to open. Oxytocin makes contractions like the rolling hills of the country side where as Pitocin makes them more like mountain peaks.
One very important difference is Pitocin does not go through the blood brain barrier to tell your body to produce endorphines to help you with the powerful sensations of labor. It also can push a labor as well as a baby to the point of exhaustion. Sometimes, it is a great choice to help get the labor going or help move it along when there is a reason to help the baby be born sooner.
Oxytocin does go through the blood brain barrier. It actually helps secrete chemicals which calm the nervous system, bring a feeling of courage and it is the same hormone used in love making or orgasms. It asks for a feeling of safety, support, freedom and trust to foster it's best work.
An epidural is the next most common medication used in labor. If you look at the average use thoughout the USA, it ranges from 36.6% to 80.1% depending on the state you live in. Why do so many women opt for an epidural medication? Fear of pain, lack of belief they can handle labor, and lack of awareness and education of what birth is actually doing. The most common one, "everyone is having one so it must be the right choice."
In the 1920's-1960's women were told the right choice was to have "twilight sleep" for labor. Women were given medication when they were 2-3 centimeters dialated. They were told everything would be taken care and you won't remember a thing.
After birth there baby who had been bathed, dressed and fed was brought to the mother. What they were given was a drug known as Scopolomine which caused amnesia and morphine a narcotic for pain. Morphine also suppresses respiration for the baby if given within 2 hours of birth.
During this era the women still labored but without the ability to cope with the sensations of birth. The drug caused hallusinations and thrashing so they were bound and restricted to a crib bed to protect them from harm. No support people were allowed. When they were fully dilated they were transfered to an operating/delivery room table. Given a larger dose of both medications and then they were cut from vagina to anus to widen the path to put forceps around the babys' head and pull them out. The baby was significantly druged and had to be hung upside down by their ankles, smacked several times on the bottom, thumped on their chest and even put in a cold/hot water to stimulate them to breathe.
"There were some strange conditions that went along with the use of these drugs. Because the women’s state of suspension was precarious, women in twilight sleep were kept in padded, crib-like beds, with eye masks blocking out the light and cotton balls in their ears blocking out sound. Sometimes they were fitted into straight-jacket-like shirts that limited the movement of their arms. When the birth was over, women also often experienced a moment of dissociation, as Carmody did: Had they really had a baby? Was the baby they’d been handed really theirs?" Atlas Obscura" IN 1914, FEMINISTS FOUGHT FOR THE RIGHT TO FORGET CHILDBIRTH
They thought this was saving women from the perils of childbirth. They thought they were doing something good for women and the baby. Today we know this is absoluty not the case.
As epidural became a good alternative to the way birth occured in most hospitals. They learned the medicationwas so detrimental to the women and their babies. Women began to request a different way of giving birth. They wanted to be awake and more present to witness their babies birth. However, the philosophy still continued to inform women generation after generation that birth was dangerous and women can't do it without the help of medicalization and medication to numb them from the experience.
For some women, an epidural is an important and valued part of their birth experience when its needed . For others, their desire is to experience labor without it.
My goal is education—so you understand what can happen when an epidural becomes part of your birth and can make the decision that feels right for you.
What Is an Epidural?
An epidural is regional anesthesia. Medication is placed into the epidural space near the spinal nerves to reduce or eliminate sensation in the lower part of the body.
It can provide significant pain relief, but it also changes some of the normal physiology and mobility of labor.
And because one intervention can create a need for another, it is helpful to understand the potential ripple effect.
Let's look at some of the things that may accompany an epidural.
1. IV Fluids and Blood Pressure Monitoring
An epidural can cause a drop in blood pressure. Because maintaining adequate blood pressure is important for both mother and baby, IV fluids and medications may be used to help support blood pressure. If blood pressure drops and decreases the oxygen to the baby, it can cause distress leading to more interventions and surgery.
An IV also provides quick access to medications if they become necessary.
This is an important example of how one intervention can lead to additional monitoring or support.
2. Continuous Fetal Monitoring
With an epidural, continuous electronic monitoring is commonly used to keep a close watch on the baby's heart rate and the mother's contractions.
External monitors can tell the care team about the baby's heart rate and the timing of contractions, although they do not directly measure the strength of each contraction.
In some circumstances, additional internal monitoring may be considered if the care team needs more information about the baby's heart rate or the strength of contractions.
3. A Urinary Catheter
An epidural can make it difficult to feel when your bladder is full and can temporarily affect your ability to urinate.
Because a very full bladder can interfere with the baby's descent and can become uncomfortable or injured, a urinary catheter is commonly placed during an epidural.
After birth, keeping the bladder empty is also important because bladder distention can interfere with the uterus contracting effectively.
4. Limited Mobility
This is one of the biggest changes I see with epidural anesthesia.
Depending on the medication and how strong the block is, your legs may become heavy or numb. You will need to remain in bed or require assistance to change positions.
And movement matters during labor.
Changing positions, moving the pelvis, standing, kneeling, using a birth ball, and being upright can all be valuable ways of working with gravity and creating space for your baby to move through the pelvis. An epidural inhibits many of these.
Some hospitals do offer mobility and position changes with an epidural, depending on the medication, equipment, policies, and individual circumstances.
The important thing is to ask ahead of time:
“What movement and birth positions will I be able to use if I choose an epidural?”
5. Pitocin May Become Part of the Picture
This is another area where understanding the physiology is helpful.
Epidural anesthesia doesn't automatically mean you will need Pitocin. However, because an epidural can sometimes affect the effectiveness or pattern of contractions and because labor may slow by upto 40%, Pitocin may be recommended if labor is not progressing as desired.
Again, one intervention doesn't guarantee another—but understanding the possible sequence allows you to make informed decisions.
6.Restricting food intake
Birth is an experience which required calories, fluids to help with energy. The uterus is a large muscle to feed. The baby needs fuel to go through labor as well. When a mother and baby are restrictive from nourishment, it can cause fatigue in both of them. The uterus gets tired and doesnt want to work as effectively. The mother ability to cope with labor reduces. The baby get tired and begins to have fetal heart tone issues inside and after they can have trouble maintaining their temperature and breastfeeding.
7. What About Baby?
Yes, epidural medications can cross the placenta to varying degrees.
The effects on the baby depend on the medications used, their doses, timing, and other circumstances.
An epidural is generally very different from general anesthesia, where a mother is put to sleep and is often chosen because it allows the mother to remain awake and involved in the birth while providing substantial pain relief.
The important question isn't simply:
“Is an epidural good or bad?”
A better question is:
“What are the benefits, what are the possible trade-offs, and what matters most to me in my birth?”
What About the Sensations of Labor?
This is where preparation becomes so important.
Many people enter pregnancy already believing:
“When labor starts, I'll probably need an epidural.”
But where did that belief come from?
Maybe it came from your mother.
Maybe from a friend.
Maybe from television.
Maybe from hearing birth stories where the first thing someone said was, “Get me the epidural!”
Maybe you have simply never been taught another way to think about labor.
Before going straight for pain relief, consider the normal birth option first.
But I encourage you to become curious about the beliefs underneath the decision.
Ask yourself:
What do I believe labor will feel like?
What am I afraid might happen?
What would I love my birth experience to feel like?
Do I understand how the nervous system, hormones, movement, breathing, and environment influence labor?
Am I choosing an epidural because it aligns with what I want—or because I'm afraid I won't be able to cope without it?
Those are very different reasons.
One Note: Epidurals are best used after 6 cms. When used before, it can often interfer enough with labor that other interventions are needed and a cesearan section risk increases by 25%.
Birth Preparation Begins During Pregnancy
Birth doesn't begin when labor starts.
Birth preparation begins during pregnancy.
This is the time to learn about your body, your nervous system, your baby's position, nutrition, movement, hormones, birth physiology, comfort measures, and the many choices available to you.
It is also the time to examine your mindset.
If your internal conversation has been:
“I can't handle labor.”
Pause.
What if you learned instead:
“My body was designed for this process. I can learn how to work with it.”
That doesn't mean promising yourself that birth will never be challenging.
It means entering birth with knowledge instead of assumptions, preparation instead of fear, and choices instead of automatically following the crowd.
Birth Was Designed to Work
The female body has an extraordinary capacity for birth.
And yet birth can become more complicated when we introduce interventions, fear, inactivity, unfamiliar environments, or beliefs that tell us our bodies cannot handle the process.
Sometimes interventions are necessary.
Sometimes they are helpful.
Sometimes they are life-saving.
And sometimes a parent simply chooses them because the benefits feel greater than the trade-offs.
That is exactly why education matters.
You deserve to understand the choices before you are in the middle of labor trying to make them.
Ask Yourself What You Would Really Love
Instead of beginning with:
“How do I avoid an epidural?”
Try beginning with:
“What would I really love my birth to be?”
Maybe you want to feel:
Calm
Confident
Powerful
Peaceful
Supported
Encouraged
Connected to your baby
Free to move
Involved in your decisions
Then begin learning what can help create that experience.
And if you ultimately decide that an epidural is part of the birth you would love, you can make that decision from knowledge rather than fear.
That's empowerment.
Natural Childbirth 101 Is Here to Help
At Natural Childbirth 101, my goal is to give you the education and tools to understand birth so you can make decisions that are right for you and your baby.
Pregnancy is a preparation time—not only for your body, but for your mind, emotions, and confidence.
The earlier you begin, the more opportunity you have to learn, practice, ask questions, and develop a mindset that supports the birth experience you would love.
You don't have to follow the crowd.
You don't have to prove anything.
You simply deserve to know your options.
Be powerful. Be purposeful. Be informed.
Pregnancy is a time of becoming—becoming a parent, becoming more aware of yourself, and discovering a new version of who you are.
And just like your baby is growing every day, so are you.
Warm hugs,
Kaleem Joy, Licensed Midwife, Transformational Mentor, Speaker, Natural Childbirth 101
Childbirth education, Birth classes online, natural birth, midwifery, birth centers, pregnancy classes, breastfeeding classes, breastfeeding, postpartum classes, VBAC, homebirth, home birth, waterbirth lamaze, doula, midwife
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