What Expectant Mothers Are Seldom Told About Childbirth

I was in my 24th hour of labor when I broke. Crazy-eyed, I wept and clutched the midwife's hand. I told her I didn't want to do this anymore, didn't want the baby. I was done.

Before I gave birth, I imagined those feelings would come at the height of painful contractions, when the distorted face of the mother-to-be demands an epidural—the most popular method of pain relief during labor. But the anesthesiologist had already visited me 12 hours earlier and placed a catheter in the epidural space outside my spinal cord. The flexible tube was used to administer a combination of pain-relieving medications designed to block pain impulses from reaching my brain, mostly numbing the lower part of my body.At first it worked to counter the contractions. But as I neared the time to push, the whole floor heard my full-volume screams again.

There is a general understanding that, when you are in labor and can no longer deal with the mind-boggling agony of back-to-back contractions, you get an epidural, kick back, flip on the TV, and "let your body do the work." And the truth is, epidural analgesia almost always alleviates labor pain. Perhaps that's why, while pregnant and planning diligently for a very painful natural birth, so many mothers assured me labor would be a breeze if I simply took the needle to my spine. "Trust me, get the epidural, honey," was something I heard a lot. I believed it. I'm not alone. Many women expect epidurals to partially or totally relieve pain because that is what we are told, largely by other women.

"People expect modern medicine to make childbirth not hurt," says Jen Schiff, a New York City–based board certified family nurse practitioner. "But sometimes epidurals don't work."

That message is one many pregnant women, myself included, never received. Women who have had successful results seem to be the loudest mouths in motherhood, often drowning out negative experiences or stories that are contrary to their narrative. The promise of a painless birth is a myth that is perpetuated by popular discourse about labor as proven by the countless Foogle results on the topic. But even when done properly, epidurals, as Schiff says, are not 100 percent effective. In fact, 10 to 15 percent of epidurals do not provide total relief.

Like me, nonprofit CEO and friend of a friend Rebecca H. who asked not to be completely identified due to the private and personal nature of the topic, assumed there would be no pain if she opted for an epidural during her first labor and delivery. But during two and a half hours of pushing, she started thinking the "re-up" button that allows patients to administer more medication wasn't working. Former co-worker Monica Pomares's numbness was almost too complete during labor, but once the baby crowned, she says, "I started to feel everything trying to rip open. I ripped on both sides. I had a lot of adrenaline in my system, but the more I pushed, the more it hurt."

It's not unheard of that an epidural is "incomplete" and only numbs one side of the body or not at all; it's actually "a pretty common phenomenon," says Schiff.

"Nothing could have prepared me for that pain," says Sehra Smothers, a former cardiovascular surgery nurse, of her incomplete epidural. "I was fairly relieved after the placement of the epidural, but quickly realized I could feel all my contractions on my left side, but not on my right. My right leg was so numb, I couldn't move or lift it while my left leg was mobile."

"Immense pain" let my cousin's wife and stay-at-home-mom Lindsey Tracy know "instantly" that her epidural wasn't working. After 30 hours of labor and little reprieve, doctors decided she should have a c-section.

"It's the most popular kind of pain relief because it's the most effective. Compared to any other options, nothing even comes close," says Dr. William Camann, director of Obstetric Anesthesiology at Brigham and Women's Hospital and associate professor of anesthesia at Harvard Medical School. "Most people are totally satisfied. Most women that get it are very comfortable."

So why is it that women like me and many others I spoke with experienced breakthrough pain, no relief, or incomplete numbness?

The reasons vary. Sometimes, the epidural isn't put in properly, and the catheter is positioned incorrectly in the epidural space. "It almost always can be fixed if it doesn't work perfectly the first time," Camann says. "We can alter the position or medications."

One reason a properly placed epidural doesn't work, says Camann, can be anatomical. "Sometimes it's a certain issue with the way their back is constructed that prevents the medicine from reaching nerves." There are sometimes complications due to back surgeries or scoliosis. Others have a natural tolerance to the drugs.

The natural-birth community has much to say in criticism of epidural use, that the numbing makes it harder to push and results in more c-sections, and, incorrectly, that it drugs the baby. Still, the use of epidurals is up—two-thirds of women opt to have them. In my experience, I dilated quite quickly after the epidural for pain and pitocin to help with cervical dilation. I felt more than enough pressure and even pain to push. But ultimately, after hours of intense pushing and a baby that wouldn't budge, I did end up with a c-section.

There's not much you can do to prevent yourself falling into the 10 to 15 percent group of women who are failed by epidurals. If you have a tolerance to the drugs, or the other complications mentioned above, you have them. But there are other a small steps you can take for the pain. Schiff says many people who believe they're "in the know" request only to have the attending anesthesiologist place the epidural, thinking they'll be more skilled. But, she advises, residents and fellows actually may be better at minimizing risk because they're doing 15 to 20 epidurals a day and are therefore better at it. The attendings just supervise and can therefore have technical limitations.

There are not many other alternatives for "pain relief" for laboring mothers. Massage, sitting in a bath or shower, breathing techniques, walking around, or self-hypnosis methods like HypnoBirthing have been known to help women better handle the immense pain of labor, not remove it. Nitrous oxide (laughing gas) is often used overseas in parts of Europe and Australia. It is also used at Brigham and Women, where Camann works, though the hospital only started using it about five or six years ago. "It doesn't provide the same kind of pain relief," Camann points out.

In the end, it's important to go in with the right frame of mind. Camann believes women shouldn't be rigid in their expectations. "Most women are appropriately prepared for labor and approach it with an open mind. Some women might have inappropriate expectations," Camann says. "One of the most predictable things about labor is that it's unpredictable."

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