While you may feel that you want drugs, underneath that, what you probably want is to avoid pain. Having an epidural is by far the most effective pain relief option during labour. But while it eliminates pain on the front end, it may cause more on the back end.
Here's an example – you get the epidural and all the labour pain goes away. The epidural slows down the contractions, so they give you Syntocinon (Pitocin in the US) to speed things back up. Soon it's time to push. The midwife lowers the bed and has you put your feet in stirrups or pushed up against you, with your knees up. She watches the monitor, and when a contraction hits, she tells you to hold your breath and push until your face turns purple. You can't really feel what's going on, just pressure, and after several pushes the baby finally comes out crying ” you did it!
“Second-degree tear,” you hear the doctor say – or worse, “Let's repair the episiotomy.” Because you couldn't feel how you were pushing, and because your provider had you flat on your back and put no counter-pressure on your perineum (the skin between the vagina and anus), you tore (or were cut, or were cut and tore some more.) Or even worse, they needed to use a vacuum or forceps to supplement your pushing and get the baby out. Then you will be stitched. If the anaesthesiologist did a good job, you still don't feel a thing… but just wait. When that epidural wears off and you finally feel those stitches down there ” OUCH! Many women have said that recovering from stitches is worse than the labour itself. You can't sit, you're afraid to poop, and sex hurts for months.
Here's another common scenario: you get the epidural, contractions slow down, they pump up the Syntocinon, break your water, and 6 hours later the baby just isn't descending – and his heart rate is dipping. Epidurals contribute to what's called “malpositioning” of the baby. And when this happens, the recourse is often a cesarean section. Again, you probably won't feel much during the surgery, but then the drugs will wear off. The recovery can be gruelling. Your abs have been severed, and without those muscles it will be difficult to even pick up your baby. If you're amongst the unfortunate 1 in 5 who contract an infection post-surgery, the pain and nastiness will be even worse.
The bottom line is that childbirth is a huge physical act that involves pain for most who experience it. But the pain of labour, it turns out, is important. It is hormonally tied to healthy labor progress. If you take away the pain, you may take away the progress, which requires intervention that can cause harm (and more pain!). Your doctor/friend/mother-in-law may be saying, “Don't be a hero, get the epidural!” But this isn't about heroics, this is about protecting your body. It may turn out that after hours of labour and every other trick in the bag, an epidural is just what is needed to facilitate the baby's appearance. But research suggests it's best left as the serious medical intervention it is ” taken when really needed.
That's not to say that women who shoo away the anaesthesiologist don't need help getting through the pain ” massage, a deep warm tub, a shower, hypnosis, and relaxation techniques can all help. Most importantly, you need to be able to move your body. What you don't need is to be stuck in a situation with access to none of these options, or in a hospital bed with an electronic fetal monitor tying you down and a Syntocinon drip in your vein. Indeed, if you're pushed, an epidural may be the only way you can get through it. It's nonsensical to expect a woman to labour without drugs if she's strapped flat on her back.
That's why it's imperative to line up a supportive provider, (a great idea is to include a doula) and atmosphere before labour starts. Women who get this kind of support are more able to stay upright, active, and in control of pushing, and are more likely to have an uncomplicated birth, an intact, uncut vagina, and a speedy recovery.
See also this article by Dr Sarah Buckley on the real risks of epidurals including a stack of references.
In the meantime, check out this clip from The Business of Being Born which talks about the effects of the use of Pitocin/Syntocinon and also what happens as a result of having an epidural early in labour.