"Please Just Get the Epidural" said the OB

A while back, an out-of-state couple of mine was trying to find a good care provider who is supportive of natural birth.  I posted the question on my BFBS Facebook page and several of you jumped right in with some great responses.  One person simply stated, "Just tell the doctor you don't want medicine."  She deleted the comment, but it had gone to my email first.  I'm not sure why she deleted it.  I reflected on her comment the rest of the week.

If only it were that easy - just tell your OB that you don't want medicine.  And yet, for the majority of women that choose to birth without medication, it's an uphill battle.

Why I (Your OB) Push the Epidural

First, if I'm an OB, I rarely see a birth without medication, mostly because the majority of women want the epidural.  It's what I am comfortable with.  It's what I learned in medical school and in my residency.  It's what I do.  When you tell me that you don't want the epidural, I think, "I've heard this one before!"  Lots of women tell me that, but few actually follow through.  I can have a great influence in how your labor goes.  I'll play along though and tell you exactly what you want to hear.  A couple of my favorite lines:

"You can hang from the rafters for all I care!" (She's making fun of you with a statement like this.  She believes that a civilized woman would never choose to birth without an epidural.  She doesn't get it.)

"As long as everything is going smoothly for baby and everyone is safe, I'll let you do whatever you want."  (A statement like this reminds a confident woman that birth is dangerous and she might need to be rescued.  It's definitely passive-aggressive.  You think you're getting what you want, but really, the doctor is putting you exactly where she wants you -- on the verge of thinking you and your baby are not safe. She will come up with a reason to interfere with your labor.)

Unless your care provider is actively helping women have unmedicated births, she doesn't know how to help you.  Just because she is catching babies doesn't mean she knows a thing about natural birth. 

The noises of a laboring woman make me very uncomfortable, all the moaning.  If she's doing it "right" they sound a little too sexy. Eew.  You can tell a lot about where she is in her labor, and more importantly, how she is handling her labor.  Are the sounds high-pitched and short breathed?  She's struggling.  Are they low and long deep breaths?  She's on top of it.  Is she tightening during contractions or letting it all hang out?

Back to my roll-play as the OB, I like it when you have an epidural because ultimately, I'm in control of your labor.  I can increase the pitocin and really get this show on the road!  I don't want to be at your labor all day/night.  With an epidural, you will do whatever I want you to do.  If I think breaking your water should be done (I can come up with a million reasons why this is good or necessary for your labor/baby to progress), you'll do exactly what I say.

I also prefer you to stay in the bed on a monitor.  When you have an epidural, I like this.  You aren't going anywhere - none of this silliness of walking around, bouncing on a birth ball, or moaning like a wild animal in the shower or tub.  No, I like you acting civilized in a bed, on a monitor, preferably sleeping.

I also prefer to "deliver" your baby while you are flat on your back with the bright lights on your vagina.  Then I can see what I am doing.  You can't feel how uncomfortable this is anyway since you have an epidural.  This really makes my job much easier.  I like a compliant patient.  It's easier on my back too.  Imagine leaning over a birth tub to catch a baby!  Honestly!

In the end, if I decide a c-section is the way to go, you already have an epidural.  I can make that call and have things move super fast.  If you don't have an epidural placed early on, this delays the c-section.  I can always use general anesthesia, but then I really have to justify the emergency factor.  The epidural is just so .... easy.

So, please.  Just have the epidural and make this easier on us all.  Thank you.

Love-
Your Typical American OB

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The Birth Nazi

I am continuously amazed at the way people twist my words all around.  I have a friend that said that to me the other day.  She said the comments I get on my blog are consistently 50/50 -- some supportive, some thinking I'm void of any compassion whatsoever and have totally lost my marbles.

Most of you don't know me in real life, but suffice it to say, I am very much the same sitting here at the computer as I am in person.  I will tell you what I think, and I'm OK with you telling me what you think, as long as it is kept respectful.  That's why I do not delete comments from my blog, even the ones that more or less call me a Birth Nazi.  You have the right to your opinion, just as I have the right to mine.

Before I go any further, I want to address my use of the word "Nazi" in this post.  I am using this word because I have heard myself referred to in this manner.  The "Soup Nazi" episode of Seinfeld has been laughed about for years, but when used in this manner, it's not funny.  At least I don't think it's funny.  I, personally, am quite offended by the use of the word, especially in reference to myself.  

Let's address a very interesting topic that I read several blog posts and Facebook statuses about this week:  Is it OK, even good, to expect a good birth experience?  According to most of them, no!  At least this is my interpretation:  You shouldn't get your hopes up because you might be let down.

A very fast recap of my birth experiences:  I have had 4 different births.  My first was an epidural birth where I narrowly escaped a c-section.  My second was my most emotional where I definitely experienced that "birth high." My third sucked and was my hardest (no one's fault but my own), and my fourth was the "easiest" but emotionally hard knowing it was my last and my son would never have a brother.  The only birth I cried tears of joy was my second.  The others, I was just mostly glad they were over.  Does that mean they were bad births because I didn't weep with joy?  Of course not.  They were all just different.  I learned very different things from each experience.  I hope those things I learned, I am able to pass on to my students.  Sometimes it's a case of "Do as I say, not as I did!"

There is this idea that Donna Ryan is an unforgiving natural childbirth educator.  If you have an epidural, I will make you feel awful about it.  And a c-section, forget it!  You might-as-well crawl into a hole!

OK, this is what Donna Ryan teaches.  Pay attention, Donna-haters!  I believe that there are some really awful OBs out there that are happiest when they are performing surgery.  They know nothing about natural childbirth and frankly, don't want to know.  They will scare you into an induction or make you beg for an epidural ("haha, let's keep her pit turned high and strap her to a monitor!"), or they will give you an episiotomy so long you will wish you had a c-section.  (Yes, I've heard a nurse say she heard an OB say this.) Are all OBs like this?  Of course not.  They do exist.  I think that the majority of them have not attended natural, intervention-free births enough to know what that looks like, sounds like, or how to help and encourage a couple on this journey.  Most of them will find a way to put you on their turf, where they are comfortable -- in a bed, strapped to a monitor, legs in stirrups, epidural, pitocin, etc.  See past blog post.

There are other resources in your community.  You may have to dig around to find them, but they likely exist.  Resources that support and encourage natural normal birth.  In Fort Worth, Texas there are so many resources available to families -- amazing midwives, in and out of the hospital.  With choices available, you need to use them.  These are the people who will help you have the birth you want -- or in some cases avoid the birth you don't want!  They encourage you to do the opposite of the (bad) OBs;  things like walking, intermittent monitoring, light food and drink throughout labor, choice of pushing positions, and just plain ole encouragement!  What a difference between a nurse (or midwife) saying, "You got this!  You sound wonderful.  Keep making those low, slow sounds," and "Oh, honey, if you think this is hard now, just wait till you're an 8!  Are you sure you don't want an epidural?"  Well, when you put it that way, of course I want an epidural!

I expect my couples to make the appropriate changes if necessary.  Don't ignore the red flags!  Nearly everyone that sits through my class does change their care provider and/or hospital if they see those red flags.  If you ignore them -- now, this does sound harsh, but it's true -- you have no one to blame but yourself for a "bad" birth if you do not make the necessary changes during the pregnancy.  It's not much fun to be left wondering if that c-section really was necessary. 

Your labor should be a wonderful, yet challenging, time in your life.  Your birth team is critical.  I've said that a million times here over the last three years.  Birth is probably the hardest thing you will ever do.  I never paint a rosy picture.  We don't get to pick the way your birth is going to play out, but you will have a very good idea of what normal birth looks like.  We go through lots of variations of normal too.

This is what I teach about an epidural:  You know what normal birth looks like.  You know what to do, what not to do, you have prepared in every way possible (birth team, relaxation, exercise, nutrition, hired a doula), and you know when you are out of the "normal" range, which can mean a lot of different things.  You have the education to know when you are on the path to a c-section.  Many an epidural has saved a mom from a c-section.  We all hope that an epidural is not a part of the birth equation, but sometimes it is, and sometimes it's even a good thing, a necessary intervention that saves a mom from a c-section.

I have never -- not even once -- told a mom that she failed when she had that epidural.  Or a c-section.  I would never do that.  In many instances, I've put myself in their shoes, and have no doubt that I would have made the exact same decision.  Now, I can't say that a mom won't beat herself up over it, but it's not because I made her feel bad. 

Here's the reality:  When people sit through my class and do all the "right" things and their birth does not go as they had hoped (epidural, transfer, c-section), rarely do I have someone seem to dwell on it and have a hard time getting over it.  Most people know that there are things in birth that are not within our control, but you do your part, roll with the punches, understand why those things became necessary in your birth, and move on!  Learn from them.  Don't become a victim of your birth!  I am seeing this all the time.  It's exhausting.  Your birth does not define who you are as a person.  How you deal with things that happen in your life is more important than the actual things that happen. 

There are some midwives that have told me that the reason they refer to my classes is not necessarily because they love The Bradley Method®, but because my couples seem to bounce back easier when things go differently from their original plans.  My couples also know that they can trust them to help them on this road and if they say they need intervention or medication, it's OK to trust them.  Attitude is everything.

I simply want to see women believe in themselves enough to give birth their all.  Sometimes, that may not mean an unmedicated birth.  It might even mean a c-section in the end.  But if you do your part -- not just become a victim of a very broken maternity system -- you will have a good birth!  Does that make me a Birth Nazi?  Then so be it.

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"My" Epidural

Have you ever noticed that when a woman refers to getting an epidural, she uses the word "my" epidural, not "an" epidural?  It is the only time I can think of off the top of my head that someone refers to pain medication as "mine."  If I have a headache, I don't say, "I took 'my' ibuprofen."  I say, "I took 'some' ibuprofen." 

So why is there ownership of the epidural?  Even the L & D nurses refer to it as "your" epidural, or "her" epidural.  You own it -- you better claim it before someone else steals it!  It is the weirdest thing.

When doctors in Europe were using a combination of different drugs to "help" women through childbirth towards the end of the 19th century, American doctors didn't want to use them.  They didn't feel they were safe.  I know, hard to imagine now, isn't it?  It was the women who demanded to have the rights to these drugs.  Up to this point, the majority of American births were assisted by midwives, not doctors.  More than 95% of all American births took place at home.

Much like today, women were afraid of childbirth, just for different reasons.  When male doctors started assisting in childbirth, women were willing to put modesty aside (no small thing) at the promise of having "pain-relieving" drugs for childbirth.  The doctors found it easier for the women to come to them in the hospital rather than have to travel to their homes.

And so it began.  Hospital birth.  In the beginning, only the affluent could afford to birth in the hospital.  It was fashionable to be "delivered" by a male doctor with his drugs and forceps.  Eventually, if you had a midwife-attended homebirth, you were obviously too poor to afford a hospital birth.  By 1940,  two-thirds of American births took place in the hospital.  (Both my parents were born at home.  They lived in southern Illinois in the middle of nowhere and were poor!)  By the 1950's, only 1% of babies were born at home.  It has largely remained the same after 60 years.

Historically, women fought for the right to vote just a couple of decades after drugs in childbirth were introduced, and birth was migrating from their bedrooms to the hospitals.  Women entered the workplace in the late 1930's during WWII to support their families.  During the Women's Rights Movement of the 1960s, women wanted equal pay and treatment.  We deserved it!  We wanted rights!  In the same decade, midwives began to resurface and the natural birth movement began rising up.  Make no mistake, 99% of women were still giving birth in a hospital with the drugs.  Just like today.

For the last 110 years, women have demanded drugs in childbirth because we should not have to endure the pain of childbirth, no matter how dangerous it may be for the baby, right?  As a woman, I have rights to those drugs!  I owned an epidural from the minute that pee-stick told me I was pregnant!  The doctors warned the women early on that the drugs went straight to the baby and were not good for the baby.  The women didn't care.  Today, we have doctors telling women that epidurals are safe -- there are no risks.  Why would you not have one, they say?  "There is no medal at the end of this race."  Oh, I beg to differ --  a drug-free mama and baby is quite a reward to behold.

Yes, women's rights have done some very important things.  But at what point did we get so wrapped up in our own discomfort that we can't see beyond ourselves?  Is it just human nature?  That sense of entitlement?

Here's the real kicker -- if women only knew the absolute empowerment that comes with giving birth to your baby without intervention or medications, they would understand that that is real Women's Lib.  Don't own the epidural ladies, own your birth!

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Want an Unmedicated Birth -- Or Even Just a Vaginal Birth? Hire a Midwife and a Doula

I have recently had a bad run -- lots of cesareans and epidural births.  I've thought about them a lot over the last several days and weeks, and there are some significant numbers that I want to share.

Up to now, my stats have been about 79% of people that take my class give birth without medication.  14% have a cesarean, and about 7% have an epidural, the majority of the time to avoid a c-section.

These last few months have been the worst statistics I've had in over seven years of teaching.  It's hard for me to put this out there, but I've gone back about 4 months to include a couple of classes and several DVD couples.  There are some interesting things to note, and I hope this improves future outcomes.

In the last 4 months, I've had 23 couples give birth.
10 had unmedicated vaginal births.
5 had epidurals (but still had a vaginal birth).
8 had c-sections. 

Let's break this down, starting with the 10 unmedicated vaginal births.  (This is what everyone was shooting for.)
6 hired midwives (mix of CNMs and CPMs).
4 hired an OB.
6 hired a doula.

Of the 5 epidural births:
3 had a midwife.
2 had an OB.    
Only one of these women hired a doula.  
It should be noted that a few of these women started with OBs and switched to midwives.   Length of labor and/or pushing would have certainly resulted in c-sections had they stayed with their original OBs and hospitals.
 

Of the 8 c-sections:
2 had a midwife.
6 had an OB.
Only 2 of these women hired a doula, and only one had her doula present.
Obviously, these c-sections happened for a variety of reasons, some valid, some not-so-much.  Can't ignore that 80% were with OBs.  Honestly question if they would have happened with a midwife.

Summary:  If you want an unmedicated birth, your birth team is crucial.  All the education in the world won't matter if you have a doctor who is determined that you or your baby "need" a c-section.  As for a doula, the statistics speak for themselves.  A woman who has the support of another woman in labor will almost always have a better outcome, or at least feel better about doing all that she could do to prevent having an epidural or a c-section. 

If you are birthing in a hospital, you need to hire a midwife instead of an OB and you need a doula by your side.  End of story.

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"Standing Outside the Fire"

So, I'm cutting onions and jalapenos this morning. No one is home. I have a Garth Brooks box set playing (sorry Tim!) with videos, concert clips, and interviews. I've had it for years but never watched it until this morning. It made the time go so much faster.

They showed the video for "Standing Outside the Fire". I love the song, but had never seen the video. I am such a sucker for sap! I want you to watch the video and then come back to me... (Yes, I have put videos on the blog before, but I can't remember how to do it, but if you click on the song, it'll take you right to the video.)

OK, did you love it? Are you bawling your eyes out? I was really a mess with all the onions!

Everything in my life relates back to birth. But before I went there, I couldn't help but be in awe of this mother's support for her child. The love was so evident and he had so much confidence because of her love and support. It made me think of my own children -- do I support them in their talents and ambitions? Some yes, some, not-so-much. It was a good moment for me as a mom.

Next, I couldn't stop thinking of a woman who plans and prepares for an unmedicated birth. She doesn't want to take the "easy" way out. Nearly all women will "stumble" in labor -- even if it's not obvious, maybe it's thoughts in her own head. What happens from there depends so much on her support team. Do they run to her? Do they cheer her on? Do they tell her, "Get up! You can do it!" Do they tell the doctors to "back off! Let her finish the race!"

What if this young man's parents had just sat in the stand? What would that boy have done? Do you think he would have finished the race? I do not believe he would have. It was his dad's encouragement -- the one who thought he would fail or get hurt -- who was at his side telling him he could do it! The look in the boys eyes -- my dad believes in me! -- was priceless.

And then to finish the race, running into his mother's arms, so proud. The prize at the end of labor, to hold your baby, knowing you did it!

Moms and Dads, it is not just about what mom is able to do. It is so much about her support team (doulas, nurses, midwives, doctors, mothers, mother-in-laws, sisters), cheering her to the finish line. Who would have thought that a Garth Brooks song would lead to such as inspirational birth song and post this morning! Sorry for all the crying. I hope you'll ponder this video and it's meaning in so many areas of our lives. Gotta love Garth! Now get on with your day.

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MY List of Things You Can Do to Avoid a C-Section

I've seen a couple of lists lately about the top 5 things a woman can do to avoid a c-section. While I think these lists are good, they differ from my personal list. I thought I'd take the time to write out my list. I guess I'll keep it to a top 5 as well, so as to not overwhelm anyone.

Education for both husband and wife: Some women are able to advocate for themselves in labor, but most are not. Preparation on the front-end is huge. Dad needs to know what is going on and how he can help. He needs to know what's normal and what's not. He needs to know the questions to ask. Having a doula will help with a lot of this. The doula cannot speak for mom, but dad can. I love The Bradley Method for this reason. Both individuals take responsibility for their role in the birth.

Careful Choosing of a Care Provider: Also huge. All the education and preparation in the world won't matter a bit if you have chosen a care provider and/or hospital who is determined that you need to be rescued from your pregnancy, labor and/or birth. This is the step where, if you ignore the red flags popping up during the education/preparation phase, it will bite you in the end. If you are getting information and statistics about your doctor or hospital that make you second-guess their philosophies, don't ignore them. It's never too late to switch care providers. I've had people change in the middle of labor! Typically, care providers like to see you for the last month of your pregnancy. I changed care providers at 33 weeks with my third pregnancy. A bit nerve-racking, but worth it for a great outcome. You will only give birth to this baby one time. Don't take on the "maybe for the next baby" attitude. Do it this time! Do it for this baby! If you don't know where to start, ask your out-of-hospital educator or doula for referrals.

Keep Moving - Don't Lay Down and Take It: Remaining in a hospital bed is one of the worst things you can do. They can/will strap a monitor on you and "watch" you from the nurses station. Health care at its finest! Laying around for your labor leaves it all up to your baby to make its way out. Baby needs movement. He is moving around, changing position, trying to find the easiest, most comfortable way out. If mom is moving -- walking, sitting on birth ball, pelvic rocking, rotating hips, even standing -- she's using gravity and movement of the pelvis to help her baby descend and get into a good position. Mom will have less vaginal exams (which often lead to Failure to Progress diagnosis), less time on a monitor (which often leads to a false-positive signaling fetal distress), and usually a more comfortable and faster labor. What's good for mom is usually what's best for baby.

Drug-Free Birth: I'm not just talking epidurals here. I'm talking inductions as well. Pitocin is a drug. Prostaglandins (cervical ripeners) are drugs. Baby may react "fine" to induction drugs, and he may not. There's no way to know how your baby will react. So trust in your body to start labor on its own. Don't be induced. Stadol, Nubain, Demerol -- they are all drugs that go to the baby. There will be physical results to the baby when they are born if they received these drugs -- more sleepiness, "laziness" at the breast, depressed breathing. If mom had educated and prepared herself during the pregnancy, she probably skipped this step. It's a tough thing to hear a mom's birth story and realize that her c-section was a direct result of her own actions -- induction, pain-relieving drugs, trusting her doctor, and not educating themselves on the normal process and what to do and what not to do. A woman is 50% more likely to have a c-section if she is induced, and four times as likely to have a c-section if she has an epidural. These are numbers that we simply cannot ignore.

Remain Low-Risk: If you do not take care of yourself and become high-risk, you give up a lot of power. You need to physically prepare your body to give birth by regularly doing pregnancy exercises. You need to eat the required nutrition to grow a healthy baby. A well-balanced diet with plenty of protein will benefit both mom and baby. The old saying "eating for two" does not mean eating for two adults! Be wise and mindful in your life choices. Practice relaxation every day. This will help with all aspects of your life, even after the baby comes. Keep stress out of your life as much as possible. Choose pre-natal tests wisely. There are so many that are done these days. Find out why it's being done and what they expect to do with the results. You can opt NOT to do them. Some may unnecessarily put you in the high-risk category if you test positive.

Of course, I must mention that every now and then I do have couples that do everything right and still have a c-section. I recently had one of these and it broke my heart. This mom worked so hard. I truly do not know what she could have done differently. You can't feel bad about a c-section that comes out of a situation like that. I feel sad for her. She really wanted a natural, unmedicated birth, and was so prepared. ICAN will be an important part of her healing.

My c-section rate of people who take my class is 14%. Some of those were necessary and some were not. Most that were not necessary can be traced back to one of these steps. One other way that can often help prevent a c-section is not rushing off to the hospital the minute your water breaks or you realize you are in labor. The longer you are there, the more excited everyone is to intervene.

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Do Epidurals Affect the Baby?

In class last week, I had a couple express surprise when I said that all drugs get to the baby, including epidurals. They have friends that are doctors that have said otherwise. I have spent the week looking up several articles and resources, and, my friends, epidurals indeed adversely affect the baby. I do not want to make this an overwhelming post, so I will touch on the highlights of how the babies are affected.

First, it is important to note that the "older" studies with very significant data were largely done by pediatricians. The newer studies, found to not be nearly as complex, have been done by anesthesiologists. Obviously, there is a conflict of interest there!

There are a couple of problems that researchers have run into with these studies. The first is that so many women that have epidurals also have other "pain relieving" drugs in their bodies that also influence and affect the babies. This makes it difficult to assess the effects of just the epidural. In addition, epidurals have different drugs in them. Different anesthesiologists and/or hospitals will often use different drugs in their epidurals.

So many of the effects on the baby have to do with the effects on the mother from the epidural. I am not focusing on the effects for the mother in this post, however, but some of these effects on the mother is what creates a problem for the baby from the epidural. For example, maternal fever is very common and can cause complications for the babies. So is a drop in maternal blood pressure. This is why a woman will receive IV fluids before the epidural is administered -- it is a preventative measure.

Effects of the Epidural on the Baby
Epidurals can change the Fetal Heart Rate (FHR), indicating that the baby is lacking blood and oxygen. This will often occur in the first 30 minutes after an epidural is placed. Opiate drugs, common in spinals and epidurals, are the likely culprit. These changes in FHR will often resolve themselves if the mom is allowed to move a bit or change position. If the baby's heart rate does not bounce back, the woman may have a cesarean section.

The supine position (lying on your back), also contributes to changes in fetal heart rate. A woman with an epidural is mostly in this position, which can deprive the baby of oxygen, affecting the baby's brain. In my case, this is why I nearly had a c-section. I had the epidural, pitocin, etc., etc., and my baby's heart rate would not come up after contractions. Moving from side to side after each contraction is what helped his heart rate. Had I remained on my back, his heart rate would not have come back up, and I would have had surgery. Had my sister-in-law, a doula, not been there, I would have had a c-section. The nurses or doctors certainly weren't telling me what to do. They would have been happy to perform surgery, I have no doubt.

Babies that are born to mothers who developed a fever from the epidural in labor are more likely to have a low Apgar score -- poor muscle tone, require resuscitation (11.5% versus 3%), or have seizures in the newborn period. One of the most common problems from the maternal fever is that the doctors do not know if the fever was from an infection involving the uterus or from the epidural. They will typically do a sepsis, or evaluation, of the baby. This involves prolonged separation from the mother, invasive tests, and almost always, antibiotics until the test results are available. In a study of first-time mothers, 34% of epidural babies were given a sepsis evaluation, but only 9.8% of nonepidural babies underwent the evaluation.

It is important to note that a newborn's ability to process and get rid of drugs is much less than an adult's. It must also be considered that the drugs are often stored in the newborn's tissues such as the brain and liver where they are more slowly released. Epidural babies are more likely to have jaundice. The reasons are not entirely clear on this, but it is suspected that it is related to an increase in assisted delivery (forceps or vacuum extraction) or to the increase use of pitocin with epidurals.

Neurobehavioral Effects
Epidural babies have been found to have a depressed NBAS (Neonatal Behavioral Assessment Score, devised by pediatricians) Score at five days old, with difficulty "controlling their state." Babies that received pitocin as well as the epidural had even more depressed NBAS scores, as well as higher rates of jaundice. At one month of age, epidural mothers found their babies "less adaptable, more intense, and more bothersome in their behavior."

Other differences between epidural babies and unmedicated babies include: less alertness and ability to orient themselves. The epidural mothers typically spent less time with their babies while in the hospital, finding the more drugs they received, the less time they were with their baby.

In another study, researchers found that at three days old, epidural babies cried more easily and more often and aspects of this continued for the entire six weeks of the study. In the conclusion of this particular study, researchers expressed concern about "the importance of first encounters with a disorganized baby in shaping maternal expectations and interactive styles."

Finally, the effects of an epidural on breastfeeding must be addressed. The first hour is a critical time to establish breastfeeding and if a baby has poor muscle tone or sucking reflex, or mom is hemorrhaging (more likely with an epidural), breastfeeding may be put off until well past that hour. As I write this, I have mixed feelings. It is crucial that mothers understand the effects of their actions in choosing an epidural, but if something happens and for whatever reason you cannot breastfeed immediately, do not give up since you missed out on that first hour. Babies and moms can figure this out! With that being said, I will continue on the effects of the epidural on breastfeeding.

Oxytocin is a breastfeeding hormone. If a mom has been induced with pitocin, administered an epidural, had an instrumental delivery, etc., this hormone was not allowed to be present in its natural form. There were just too many disruptions. This can adversely affect how well breastfeeding gets started. If mom is tired, baby is still feeling the effects of the drugs and not sucking well, the nurses, and even the pediatrician, may be pushing formula on this baby. And then starts the vicious cycle of nipple confusion. The baby doesn't have to work to get milk from the bottle, and when he is put to the breast, gets frustrated. Mom gets frustrated and resorts to those stupid formula samples she's been receiving on her doorstep for months!

Epidural mothers are less likely to breastfeed exclusively compared to nonepidural mothers. Epidural mothers are more likely to report having "not enough milk."

It is unfortunate that doctors are leading people to believe that the epidural is safe for moms and babies and there are no risks. There are risks, not just to our health, but to how we parent our babies. The more attached you are, the better you will appreciate your baby. You will trust your body to breastfeed and your baby will be eager to nurse.

I'd like to end with a quote by musician, Ani DiFranco, talking about her unmedicated birth: "I'm really happy in the end that I felt every last bit of the pain, and was as present as I could be. Whenever you go through something terrifying and come out the other side, you grow and have more self-respect in terms of your own strengths. I wanted that more than I wanted whatever sort of numbing the hospital would have offered."

What's good for mom is good for baby. Just say NO to the epidural! You are strong and powerful. You can do this, just like millions of women before you have done this. Giving birth is giving life. You and your baby deserve the very best start down this new road. Surround yourself with positive people who believe in you and your abilities.

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