Nevertheless, these trials suggest that epidurals are, at the very least, no worse than other drugs given for comfort. A 2011 analysis of six randomized controlled trials published since 1995 and involving more than 15,000 women concluded that even when given early in labor (before the cervix is 4 centimeters dilated), epidurals do not increase the risk of C-section compared with other pain medications. A similar study published in December 2011 looked at 38 randomized controlled trials and concluded the same thing.
There is one study that did break with convention—and conventional ethics—to compare women who received epidurals with those who received no drugs at all in a randomized and controlled manner. This trial, published in 1999 by researchers in Mexico, gave epidurals to one-half of a group of 129 women who were in labor, while leaving the other half unmedicated. Then the doctors recorded how long it took for their patients to dilate and deliver, what type of delivery they had, and how much pain they said they experienced. The women with epidurals did, in fact, dilate more slowly and take longer to deliver, but they were no more likely to undergo C-sections than women who did not have drugs. And unsurprisingly, 100 percent of the women who had no drugs described their labors as “very painful,” compared with just 9 percent of the women with epidurals. But U.S. researchers know very little about this study other than the details described in its abstract, and it is rarely referenced in literature reviews.
Based on all of this evidence—which, of course, is far from perfect—the American Congress of Obstetricians and Gynecologists published a position statement in 2006 concluding that “the fear of unnecessary cesarean delivery should not influence the method of pain relief that women can choose during labor.”
There are other factors to consider when pondering epidurals, too. Some (but not all) research suggests that they, more than other drugs, increase the risk that a doctor will use forceps or a vacuum extractor to pull the baby out of the birth canal, which can cause bruising and jaundice in the baby as well as vaginal injury. But newer epidurals reduce this risk: In 2001, researchers randomly assigned women requesting epidurals to receive either the “old” 0.25 percent local anesthetic infusion or the new low-dose formulation and found that the women with the newer epidurals were 9 percent less likely to have instrumental deliveries. And since epidurals minimize pain, they keep the mother from hyperventilating, which is thought to improve oxygen availability to the fetus. Epidurals may also have subtle effects on a woman’s physiology, lowering her blood pressure (which can be a benefit or a drawback depending on her blood pressure status in labor) and inducing a mild fever 10 to 15 percent of the time. Finally, epidurals do seem to lengthen the final stages of labor by about 15 minutes.
What about breastfeeding? Natural birthers claim that epidurals impede post-birth breastfeeding because they make babies drowsy. But again, based on the science, it is unclear whether epidurals actually cause breastfeeding problems or are just associated with them. C-sections and other complicated deliveries often require epidurals, and these types of births do impair breastfeeding—but that could be because recoveries from such deliveries are long and painful, not because of direct effects from the epidural. A 2010 study published in the International Journal of Obstetric Anesthesia followed 87 women who had epidurals during labor and reported that 95 percent of them were successfully nursing six weeks after delivery. As for whether epidurals make newborns sleepy: A 2011 study published by nurses at the University of Illinois at Chicago reported that women who received epidurals had similar levels of the stress hormone cortisol in their umbilical cord blood immediately after birth as women who had no drugs. Since cord blood cortisol is a good proxy for newborn alertness, the findings suggest that epidurals probably have no effect.
All in all, then, how dangerous are epidurals? One could make the case that it’s silly to experience such agony on account of putative risks that don’t concern the clinicians who deliver dozens of babies each week. At the same time, these doctors may be biased, and the science on epidurals will never be 100 percent certain. To confuse things further, the issue is growing more polarized. Celebrities including Ricki Lake and Gisele Bündchen have gone public about why they chose natural births; anesthesiologists have published books about why women should embrace epidurals, arguing that they might even be beneficial because they reduce the baby’s exposure to labor-pain-induced stress hormones.
Women shouldn’t cave to pressure from either side. They should make informed decisions based on their goals and priorities. I aspired to have a comfortable birth even if it meant being surrounded by nurses and doctors and tubes and incessant beeps; other women may trade pain for a more intimate birthing experience. Each choice comes with its own benefits and unpleasantries. My unnatural childbirth left me with a memory that does not involve intolerable pain, and that’s exactly what I wanted.