Understanding the Epidural Cascade: What Every Parent Should Know

As family wellness chiropractors, we often talk with expectant parents about their birth preferences and hopes for a natural, unmedicated delivery. While medical interventions can be life-saving and are sometimes necessary, it's crucial to understand how common procedures like epidurals can initiate a chain of events—what we call the "epidural cascade." This isn't to demonize epidurals or to scare you, but to empower you with knowledge so you can make informed choices that align with your family's holistic health philosophy.

What is the Epidural Cascade?

An epidural is a regional anesthetic injected into the space around your spinal cord, numbing your lower body and providing pain relief during labor. It’s important to know here that in up to 20% of women, epidurals either fail completely, or have failure “windows” or areas of the body where no pain relief is provided at all. While usually effective for pain, it can have several downstream effects that may increase the likelihood of further interventions. Let's break down some of the common steps in this cascade:

1. Reduced Mobility and Slower Labor:

   • The Effect: Once an epidural is administered, your ability to move freely, walk, and change positions is significantly limited. You're often confined to the bed.

   • The Cascade: Movement and gravity are incredibly helpful in labor, encouraging the baby to descend and rotate optimally. Lack of mobility can slow down contractions, prolong labor, and potentially lead to a "stalled" labor diagnosis.

     
     

2. Increased Need for Pitocin:

   • The Effect: When labor slows after an epidural, medical staff often recommend synthetic oxytocin (Pitocin) to augment contractions.

   • The Cascade: Pitocin-induced contractions can be more intense and less physiological than natural contractions. This can be more stressful for both mother and baby. Occasionally at this point, when labor is already “stalled”, the effects of the epidural can wear off and contractions will be felt at this higher intensity, leading to a need for more pain medication through the epidural, leading to need for more pitocin, and the cycle goes on. 

     
     

3. Fetal Monitoring and Positioning Challenges:

   • The Effect: With an epidural and Pitocin, continuous electronic fetal monitoring is often required, which further restricts movement.

   • The Cascade: Lying on your back for monitoring can compress major blood vessels, potentially reducing blood flow to the baby and causing decelerations in the baby's heart rate. This might lead to concern from medical staff and further interventions.

     
     

4. Increased Likelihood of Assisted Delivery (Forceps/Vacuum) or C-section:

   • The Effect: If the baby isn't descending well or is showing signs of distress due to prolonged labor or positioning issues, interventions to expedite delivery may be considered.

   • The Cascade: The numbing effect of the epidural can make it harder for the birthing parent to feel the urge to push effectively, and can also impact the baby's ability to rotate as needed. This can increase the chances of needing an assisted vaginal delivery (with forceps or vacuum) or, if progress continues to stall or fetal distress is significant, a Cesarean section.

     
     

5. Postpartum Considerations:

   • The Effect: While not directly part of the "cascade" during labor, interventions can have postpartum implications.

   • The Cascade: A C-section, for example, is major abdominal surgery with a longer recovery time, potential for pain medication, and a different initial bonding experience. As well, more interventions can often mean a need for more fluids through IV, which can affect breast size, milk production, and baby’s ability to latch after birth. Even an assisted vaginal delivery can lead to more significant tearing and recovery.

     
     

Empowering Your Birth Choices

Understanding the epidural cascade isn't about fear; it's about empowerment. Here are some ways to approach your birth plan with a holistic mindset:

• Educate Yourself: Take comprehensive childbirth education classes that cover both physiological birth and common interventions.

  
  

• Discuss with Your Provider: Have open conversations with your obstetrician or midwife about your preferences, their typical practices, and when they would recommend interventions. If you and your provider are not aligning with your birth plan, it might be time to look for a new provider.

  
  

• Consider a Doula: A doula provides continuous physical, emotional, and informational support during labor, which can significantly reduce the need for interventions.

  
  

• Prioritize Mobility: If you do opt for an epidural, discuss strategies with your medical team to maintain as much mobility and position changes as safely possible. Some hospitals offer birthing props to help you change positions even with an epidural. 

  
  

• Trust Your Body: Remember that your body is designed to give birth. Connecting with your innate wisdom and trusting the process can be incredibly powerful.

  
  

At our Evergreen, we believe in supporting your body's natural ability to heal and thrive, and that includes during pregnancy and birth. By understanding the potential ripple effects of interventions like the epidural, you can make choices that best support a healthy, empowering birth experience for you and your baby.

If you have questions about preparing your body for birth, or want to discuss holistic approaches to pregnancy wellness, please don't hesitate to reach out! We’d love to chat with you about your options.