It seems that there are few things out there as polarizing as labor.  I know, I know, labor shouldn’t be a polarizing issue because it is a natural process and we should just leave well enough alone.  I agree there are many times health care providers add things to the labor process that are not always necessary, but the oft public opinion is that we are doing so because we as providers are too much into the technology and not the natural process of labor.   I know many obstetricians that are fans of the natural childbirth.  I am more of a proponent of woman’s choice and one of the choices that many women make during labor is what to do for pain control.  If you were to ask most women that have never been in labor what they want to do for pain control, most of them would probably say that they would prefer no pain medication.  By the time active labor sets in and the reality of the pain takes hold, many of these laboring women have changed their minds because the pain is too intense.  Are we coddling these women by asking them if they would like an epidural?  Aren’t epidurals bad things that prolong labor and increase the rates of cesarean section?  Don’t epidurals interfere with the bonding between mothers and their babies?  What do you think?  I wanted to address some of the myths out there and some of the realities out there that patients have about epidurals and in the long run, remember, that it is your decision and only you know what it feels like to be in labor

1). Is it true that epidurals increase the cesarean section rate?  Well, there are many things that increase the rates of cesarean section and the epidural may be a small part of that but it is not a causal relationship.  The majority of women that have an epidural do not then go on to have a cesarean section.  The problem with the argument that it increases he cesarean section rate is the question ,”Would these women have had a cesarean section if they would not have had the epidural?” and this question is almost impossible to answer.  The reason that a epidurals potentially increase the risk of cesarean is because they do have a propensity to slow the labor process.  The reason for this process is not directly know, but it has been documented and this can be cause for the starting of pitocin  and other forms of active management of labor.  Many advocates of the natural birthing process claim that once you receive an epidural you are opening a Pandora’s Box and potentially sliding down that slippery slope towards a cesarean section

2). Epidurals will decrease my blood pressure.  This is true n some cases.  Because the epidural decrease sympathetic tone it can cause the blood vessels to relax just like the muscles, this could result in a drop in blood pressure and a subsequent change in the fetal heart rate.  If this happens the anesthesiologist will administer IV fluid or medications to increase the blood pressure.

3). I will not be able to move if I get an epidural.  Some patients have a very difficult time moving when they undergo an epidural, but in many cases you will be able to move your legs.  When you go to the dentist and have your lip numbed you can still talk, albeit not as well, but you can usually still speak and this is because you recruit the surrounding muscles to help.  This is also the case with movement of the legs.

4). I wont bond with my baby if I don’t feel the pain.  My wife had two cesarean sections and she has one of the strongest bonds with our children that I have seen.  I would challenge this statement until my last breath.  The bonding experience has much more multifactorial than just the evidence of pain during labor.

These are just a few of the myths surrounding epidurals and we go into much more detail in our book “Hands Off My Belly!: The Pregnant Woman’s Survival Guide to Myths, Mothers, and Moods” published by Prometheus Books and available at Amazon, Barnes and Noble, and Borders booksellers

Over the past few weeks I have been noticing a significant amount of discussion on Twitter, and elsewhere, that seems to be centered around cesarean sections and the horros of a hospital birth.  Personally, I think that if a woman wants to deliver at home, or in a birthing center, then she should be able to do so, and I have often joked that you don’t need an obstetrician when a baby is delivering; you need us when they are not delivering.  The flip side of this observation is that women who wish to have a delivery in the hospital should be able to do so as well, and there are many myths utilized as scare tactics.  Some of the mythical items I see on these websites are listed below.

• The cesarean section rate is high because your physician simply wants to go home and have dinner. Ultimately, this saddens me to think that women would feel like this is something an ethical physician would do.  I am sure that this happens and that it has happened in the past.  Do we like to have dinner, sure who doesn’t? Unless of course we are having fish and then I am not really excited about dinner.  My concern is that there are things being stated about perceptions of certain physicians and that maybe this fear  is based on the few doctors out there that might do something like this, but what about the thousands of us out there that put the needs of the baby and the patient above our own on a daily basis.  The fearmongering is casting doubt on a situation that needs trust and reassurance.
• The cesarean section rate has increase by almost 50% in the last decade or so.  Depending on the numbers this may be true, but why?  First and foremost, there are many women out there that would choose to have a repeat cesarean rather than attempt a vaginal birth after cesarean (VBAC).  Now, you VBACers out there hold on, I understand that many women might have a repeat c-section because of the bias physicians impose in their counselling, but what else would you have us do?  There is a 1 in 200 chance of having a uterine rupture during VBAC.  That means there is a 199 in 200 chance that this will not happen.  If there was a 1 in 200 chance that you would get in a major car accident today if you went to the grocery store, would you go or would you stay home; I think most people would stay home; so why is does it cause so much ire in the minds of those who are pushing natural birth.  If this is truly a woman’s choice then so be it and let her choose.  There are a few cases out there where women are being refused the right to have a VBAC, but if we choose to let the woman have a choice then should we not offer the same choice to physicians.  If a physician does not want to perform an abortion then we don’t make them, and we shouldn’t make then offer VBAC if they are not comfortable doing so.  They should be able to refer that patient to a provider that does offer that procedure and they should not take care of the patient until it is too late to transfer.  My point is that we should offer the same rights to physicians that we offer to patients.  I truly understand that there are risks with a cesarean section, but I have persoanlly worked at 2 hospitals where VBACing patients had uterine ruptures and in both instances babies did nto survive, and this is totally avoidable.  I’m sure there will be comments on this but it is my opinion, biased as it might be.
• Recovery from a cesarean section is more difficult than a vaginal delivery.  This is true, but mom can still breastfeed and do the things she would have done with a vaginal delivery.
• You should ask your doctor their cesarean section rate.  I don’t have a problem with a patient asking me what my rate of cesarean section is and even why, but what are you going to do with the information?  First of all, the hospital usually runs these reports for a national database and if there are providers that are coming out ahead of the hospital average then there is uually an investigation into why this one provider is falling outside of the usual.  There are also so many factors that go into the decision for a cesarean section that the data points can be skewed.  Say for instance you physician is the only physician in town that will allow patients to request a primary cesarean section and because of this these women go to his/her practice.  This might make him/her look like they have a higher rate, but their patient poulation is skewed towards cesareans sections by market factors and patient choice.
• Once a c-section always a c-section.  This is not true, but truthfully it is getting harder trying to find a provider that will do VBAC deliveries.  The pendulum is swinging back towards this rule, but we are not there

Overall, this is a personal decision and should be made with info from both you and your physician.  This topic invokes fear, anger, and potentially misleading information.  Arm yourself with knowledge and try to stay objective in the information you process.  If you trust your provider and you trust yourself then you should feel good about the choice you have made.