More moms choose to limit childbirth pain
As many as 90 percent of births at Chicagoland hospitals may include use of an epidural analgesia
Burnetta Herron-Mitchell kisses her 2-month-old daughter Rhys in the neonatal ICU at Loyola Hospital in Maywood. Herron-Mitchell had an epidural while giving birth. (Antonio Perez, Chicago Tribune)
Typically called an epidural, this type of analgesia is injected into the epidural space of the spinal cord, causing lost sensation in the pelvis.
"After having the epidural, I felt the pressure but not the horrible pain," said Herron-Mitchell, a Chicago surgeon, whose daughter was born in February. "I cannot imagine doing it without the epidural."
Obstetricians at Chicago-area hospitals estimate as many as 90 percent of local mothers who give birth vaginally have epidurals — a sharp increase from a generation ago when many women rejected pain relief to "go natural." Or, they did not have a choice because anesthesiologists were not available on the maternity ward.
Although obstetric associations do not keep a tally of the number of epidurals nationwide, making it difficult to track their growing popularity, local specialists say they've seen the most dramatic increase in the last decade.
Now, the epidural rate at Loyola University Health System in Maywood is close to 90 percent, said Dr. Ku-Mie Kim, head of obstetric anesthesiology. "It was only 75 percent 10 years ago, and lower before that."
Percentages are higher at university hospitals, added Kim, because they are more likely to have obstetric anesthesiologists on staff 24/7. "For a smaller hospital that does have one there night and day, it's a good marketing strategy," she said. "Babies come at all hours and the prospective mothers plan ahead."
Although it is not as large as the university hospitals, Northwest Community Hospital in Arlington Heights assures moms it has an obstetric anesthesiologist on staff at all times. About 80 percent of moms at Northwest have epidurals now, compared to about 50 percent 20 years ago, said a hospital representative.
The younger and more educated the mother, the more likely she chooses an epidural, according to a 2008 report from theU.S. Department of Health and Human Services. Early prenatal care and hospital (versus home) births also increase the likelihood of epidurals. White women have epidurals more than nonwhites.
"In my experience, the percentage is about 90 percent now at the major hospitals," said Dr. Cynthia Wong, professor of anesthesiology at Northwestern Memorial Hospital in Chicago. "That's up from about 60 percent 20 years ago." When moms ask her what she would do, Wong tells them she had epidurals when she delivered her biological children. (She also has adopted children.)
A very low percentage of mothers receive narcotic painkillers through IVs instead, said Wong. "That makes the baby sleepy so we don't do it unless the patient requests it or wants pain relief but cannot have an epidural," she said. Another small percentage, she said, use hypnosis or acupuncture.
"In the 33 years I've been practicing, I've seen epidurals increase gradually from about 25 to 50 percent to about 80 to 90 percent," said Dr. Lanny Wilson, an obstetrician/gynecologist at Adventist Hinsdale Hospital in Hinsdale.
The women least likely to have epidurals, said Wilson, are those who arrive at the hospital in the nick of time and those determined to eschew drugs. "Even half of the women who say that, though, wind up asking for an epidural," he said.
Epidurals are on the upswing for several reasons, said the doctors. "Patients' attitudes are different," said Wong. "They expect pain to be controlled. This is a generation of women who manage their pregnancies, their labor and their child-rearing."
"Since the 1990s, especially, the attitude toward pain has changed," said Kim. "Patients know they have a right to pain relief."
Such factors are behind Nancy Rosiles' plans to have an epidural when she has her third baby — due in early July. "I had epidurals with my other babies too," said the southwest suburban mother of two. "The doctors say it is safe. The No. 1 reason I choose epidurals? Pain."
Patients who have done their homework know that epidurals are safer and involve lower doses of drugs, the doctors said. "Now, the patient can control the epidural after the doctor inserts the catheter," explained Wong. "She can get enough to ease the pain but not so much that she is too numb."
As doctors continue to refine drug dosages and implementation, Wong said, the side effects are minimized. "One percent of patients with epidurals get spinal headaches for a few days and sometimes the epidural results in itching," she said. "But most patients choose the relief of the epidural despite those risks."
Although the average patient is more educated, the doctors said, myths still abound. "You hear that an epidural causes permanent back pain," said Wong. "That myth comes from the temporary back pain that you get after childbirth, epidural or not."
Others claim epidurals cause a higher rate of cesarean sections. "The truth is, you're more likely to ask for the epidural if you are having greater pain, which is a marker for problems that can lead to a C-section, such as a large baby," said Wong.
Others believe the baby will be born "drugged" if the mom has an epidural. "The exposure to the baby is minimal and safe," said Wilson. "It's not like narcotics, which do go directly to the baby."
Wilson said it's the obstetrician's job to counsel the expectant mom about pain relief before the baby arrives. "Sometimes, the patients' mothers advise them to 'go natural,'" he said. "But more often, they tell their daughters, 'I'm so glad you can have an epidural. It wasn't available for me.'"
"There's still a stigma among some women that if you have an epidural you're not tough," said Herron-Mitchell, whose daughter was born premature at 26 weeks. "But you have to do what's right for you. There are always risks, but you have to consider the advantages. I think epidurals are wonderful things."