Epidurals are routinely used to provide analgesia during the labor process. Many women swear by them and will request for an epidural even before they are committed to labor by the obstetrician. Others “want to be a hero” (as the saying goes), and try to tough it out without any pain medications. In the interim, their discomfort with contractions and labor augmentation causes an upsurge of stress hormones, affects their sleep, and impacts the overall quality of their birthing experience.
Admittedly, I’m a little biased, but my reason to be in favor of epidurals stems from a safety standpoint rather than solely pain relief.
A functional epidural provides a safer alternative to general anesthesia (IV medications, inhaled anesthetics, etc.) in the event of an emergent C-section. Pregnancy is associated with a myriad of risk factors for a difficult airway and trouble at induction of general anesthesia (decreased functional residual capacity, increased oxygen consumption, engorged mucosa/vasculature, increased intra-abdominal pressure). In fact, general anesthesia is associated with a higher mortality rate than neuraxial techniques (like epidurals) in these circumstances.
So in general, get the epidural early! It will provide comfort and give physicians time to troubleshoot any problems. If a STAT C-section needs to be done for nonreassuring fetal heart tracings, cord prolapse, uterine rupture, etc, the epidural analgesia can be converted to surgical anesthesia. Patients will be completely numb in the surgical site but still breath on their own. Most importantly, moms will be able to see their babies immediately which permits early skin-to-skin bonding.
For this reason alone, I think the labor epidural is well worth it! 🙂