My midwife Hayley Oakes (from my birthing center Del Mar Birthing Center) responds to your top questions about epidural-free / out-of-hospital births.
Is a drug free birth better for the baby + mom's health? Can drugs interfere/affect baby/mom and how?
Overall, as long as a woman is low-risk and healthy (no pre-existing or gestational conditions i.e. hypertension, diabetes, infection), the less interventions she has during labor and birth, the less risk she poses to her health (blood pressure, risk of hemorrhage, tearing, infection, cesarean) and the the health of her baby (ability to tolerate stress of labor and prevent any infection or breathing difficulties after the birth). An epidural affects the mother’s mobility, ability to feel what is happening in her body (i.e. when to push and when to slow down so as to prevent tearing) and if used in early labor can slow contractions down so that more medical interventions are needed to augment labor. This can lead to more interventions that ultimately puts you and baby at greater risk as well as increases the chances for a cesarean. This is major abdominal surgery with prolonged recovery time, potential breastfeeding difficulties and risk for subsequent pregnancies. With narcotic drugs (i.e. Morphine) it can make a woman feel drowsy and it also crosses the placenta so the same reaction can happen in the baby when he/she is born and those babies requires more assistance with care after the birth. Are you more or less likely to tear in a drug free / out of the hospital birth?
You are LESS likely to tear with an unmedicated birth. This is due to the fact that a woman has the freedom of movement to assume a more favorable pushing position (other than on her back if her care provider is comfortable with that). Pushing on one’s side or in hands and knees allows the sacrum to move out of the way which allows the baby’s head to stretch tissues more easily and thus prevent tearing. Also, without an epidural, a woman can feel her tissues stretch which is a good thing as it guides her pushing efforts (i.e. when to push more and when to back off and just breathe). With proper support i.e. hot compresses and verbal guidance from the care provider this can greatly decrease chances of tearing. However, I will say that even at our birth center, which are all unmedicated births, the risk of tearing is anywhere from 40-60%. They are not significant tears but it’s a common phenomenon overall - especially with first babies. With proper education about postpartum recovery, it’s a very forgiving part of your body that can heal well. Top natural things to heal (vaginally) and recover after birth? Do you recover faster after a drug free birth?
Frozen pads (‘padsicles’) made with Witch Hazel for the first 24 hours. Herbal sitz baths twice a day for the first week. Arnica (oral) to help with the swelling, bruising and discomfort. Ibuprofen (safe for breastfeeding) which helps with the discomfort so it allows you to rest more comfortably, which overall helps with healing. Dermoplast, a topical medicated numbing spray to use externally on your perineum. Mother Love also makes a good perineal spray.
When not sitting upright breastfeeding, lay on your side so as to decrease swelling in your vagina. Don’t get up to walk around the house or do chores until the umbilical cord has fallen off (7-10 days). Start to slowly increase activity i.e. walk around the block at 2 weeks postpartum. It takes a full 6 wks for the perineum to heal when there has been a laceration so take things very slow. Let your bleeding (yes, you will bleed up to 4-8 wks after you have your baby) dictate how much activity is good for you. It should be decreasing every day. If you see it increase, you have done too much.
Overall, one can recover faster after an unmedicated birth but it also is reliant upon your postpartum care with your care provider to ensure you’re taking good care of yourself while giving you helpful tips. In the hospital setting, you usually don’t see or speak to an OB after you are discharged for 6 wks. So I would highly recommend hiring a postpartum doula who can ensure proper recovery. This is not the case with out-of-hospital midwifery led care as we check in with you every day for the first week and then again at 2, 4 and 6 wks. This not only helps with perineal healing but also breastfeeding and feeling supported overall which decreases risk of postpartum depression. Can you eat during a natural drug free birth?
Yes, you can eat and drink freely during an unmedicated and natural birth. The more interventions you introduce i.e. Pitocin or an epidural, the risk to baby increases and/or for needing further interventions and potentially a cesarean. The reason why women are told not to eat in labor (hospital settings) because of the in case scenario to have an emergency cesarean and need for general anesthesia. There is a small risk of aspiration when ‘going under’ so to prevent this from happening, the hospital would prefer no food in your stomach. However, if you are low risk and your labor and birth are progressing as normal, it’s beneficial to give your body the energy and nutrients it needs when working hard for hours on end. What's a doulas role? Is it more important to get a doula if you have a drug free birth?
A doula’s role is to support the mother and partner emotionally, physically and informationally. She does not do any medical procedures with the woman. She is there strictly to ensure the mother has a positive birth experience. She typically will labor with the mother and partner in the early/active phases of labor before either going to the hospital or birth center (or midwife arriving to attend home birth). There are incredible studies that show the benefits of having a doula i.e. decreased use of pain medication, more positive attitude regarding birth experience, higher rate of breastfeeding, etc. I highly recommend having a doula for any birth setting. It also is beneficial for the partner as well - allows him/her to be themselves and enjoy the process vs being panicked to remember everything from the classes or making sure you’re comfortable. You have an experienced guide to help your partner look great and calm and suggest when it’s time to contact care provider. Does an epidural interfere with breastfeeding?
An epidural if used for hours on end in labor can potentially make a baby less active at the breast. But I have seen medicated births with positive breastfeeding experiences as well. Are IVs + nitrous oxide considered drugs? Are they invasive? Any side effects?
IVs and nitrous oxide are not considered drugs. They are considered therapeutic agents/interventions. An IV is invasive in the sense that there is line directly into a vein in your arm but otherwise, it can be very helpful especially if a woman is very dehydrated and is having trouble keeping fluids/food down due to nausea in labor. When IVs are used with a medication like Pitocin then are there are greater side effects (the contractions are stronger and longer and the baby potentially not tolerating the increased synthetic stress of those contractions).
Nitrous oxide can help with the discomfort of labor. The discomfort is not taken away completely like the intended effect of an epidural but more it allows a woman to not care so much about the contractions. It’s fast acting and leaving so it does not have time to cross the placenta and thus affect the baby. It is a more common tool for pain relief in other countries like the UK, however, more birth centers and some hospitals in the US are providing it. It is not available at home birth settings. Do epidurals interfere with the body's natural hormones created during labor?
Yes, epidurals interfere with the body’s own pain coping mechanisms. In labor, once a certain pain threshold is met, there is a cocktail of hormones that are released to help you cope. These are the pleasure hormones that include dopamine, oxytocin, endorphins, serotonin that are released when you’re in active labor and reach their peak right after the birth. When that is cut off then there is not the same release. Of course that does not mean that a woman with an epidural doesn’t experience euphoria and bliss from finally meeting her baby but there won’t be the added natural benefit that courses in your system longer as well. What are the chances of getting a C section when you are doing a home or birthing center epidural free birth?
The cesarean rate for our practice is <7% (compared to the national average of hospital births of 33%) and I would say that most home or birth center practices in this country will fall in that same statistic. A lot of people assume that when a woman needs to transfer to the hospital from a planned home or birth center birth, it must be for an emergency or for a cesarean. And the truth is transferring to a hospital from the birth center rarely is for an emergency (<1%), it’s more likely for a stalled labor, that the grand majority of the time ends up in a vaginal, healthy birth. Reasons why you would typically be transferred to a hospital if you are doing a home or birthing center birth?
One of the most common reasons a woman is transferred to the hospital, especially for a first-time mother, is arrest of dilation in the active phase of labor. The usual scenario is that it has been a long labor with perhaps a baby who is in a position that is not optimal (posterior or the woman is experiencing what’s known as ‘back labor’) and despite all of the natural remedies and corrective measures to increase the strength and frequency of contractions or help reposition the baby, the body is no longer contracting as efficiently or making progress. So the best chance of having a vaginal birth is to go to the hospital and get an epidural and possibly Pitocin to let the body rest while receiving some help to then push out your baby.
Other reasons that are not so common but do happen include: the bag of waters breaks before labor and you don’t have any contractions for 24 hours, you should go to the hospital to augment labor to prevent infection in the baby; if there is thick meconium in the amniotic fluid this can inhibit the baby from taking a nice deep breath at the time of birth so the Neonatal Intensive Care Unit (NICU) should be present; any variation to a normal fetal heart rate that is not resolvable with natural corrective measures i.e. a change in the mother’s position or giving her IV fluids; or a more significant laceration than what we can repair i.e. a third or fourth degree tear. Is a drug free labor typically shorter? Why do epidurals/drugs cause the labor process to be longer?
Drug free labors are not necessarily shorter than medicated births. I would say it has more to do with your birth setting and care provider and their support and tools for a natural birth, the individual woman’s body and health as well as her level of preparation. But on average for a first time mother, active labor will be 12-24 hours and usually women spend about 6-8 of those active labor hours at the birth center. This is very different from the birth stories you may hear of a 3-day affair at the hospital. But that is usually because those women either have what’s called prodromal labor (ongoing early labor that stops and starts) or they show up to the hospital way too early and need more interventions to get labor going. The reason epidurals can slow a woman’s labor down is that it can relax the uterus so much that it then slows contractions down. If you receive the epidural when you’re not technically in active labor <6 cm, then there is the potential for your labor to slow or stop and then Pitocin is introduced. But when an epidural, like all medications, is used judiciously, it can be the very thing that makes your labor speed up or be the difference of having a vaginal birth from a cesarean. It’s all about timing when using it and if it will really help that woman’s labor or hinder the process.
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