If you choose an epidural, will postpartum and the baby be fine? I examined the information that is spreading now

I am Ran Kawai, a childbirth journalist.
I would like to consider the commonly cited benefits of epidural childbirth from the perspective of someone who has covered the front lines of birth.

Pain relief during labor via anesthesia (epidural) is a safe method that, when performed correctly, is very effective at managing pain.

However, I recently had the opportunity to be a panelist on epidural childbirth subsidies at a conference mainly attended by obstetricians and neonatologists, and I said, "While it is good that epidural childbirth is becoming more widespread, there is too much information praising it without reservation, and I fear it is becoming a fantasy."

It took courage to say that in front of doctors who perform epidurals. However, after the session, I received many words of empathy from the doctors regarding the word "fantasy."

The reason the doctors empathized with that word is that they also felt that because epidural childbirth carries risks—and in Japan, in particular, there are strains on the medical system—more people are having excessive expectations after being exposed to laudatory information.

Whether it is an epidural or a natural birth, real childbirth is not easy. Whether you have anesthesia or not, for those who have a hard time, it is very hard. On the other hand, for those who have an easy time, it is easy. Professionals who see this reality want the image of epidural childbirth to be a bit more realistic.

Is it true that "because it was an epidural, postpartum was easy"?

Until about 10 years ago, epidural childbirth was discussed more calmly and based on scientific evidence.
In 2017, the government created a flyer based on scientific evidence with experts who have long been involved in epidural childbirth. Here it is.

In the benefits section, it states that it reduces the physical burden on the mother, but it specifies that it is advantageous for those with backgrounds such as "pregnant women with heart or lung conditions" or "pregnant women with high blood pressure."

Then, the next sentence says, "It is said that many people feel they were able to conserve their postpartum physical strength," but this means, "As a personal impression, many people say this, but postpartum physical strength conservation has not been scientifically proven."
In fact, I often ask anesthesiologists during interviews, "Is epidural childbirth related to postpartum recovery?" but I have never heard anyone say there is evidence that it makes the postpartum period easier.

Reports that epidural childbirth results in higher blood loss are also frequently heard at recent conferences. Epidural childbirth increases the rate of vacuum-assisted or forceps-assisted deliveries, where instruments enter the birth canal, and in such cases, perineal tears are often larger. Excessive uterine contractions caused by labor-inducing drugs can also lead to bleeding from the uterus or birth canal.

In the first place, what is meant by "postpartum is easy" is unclear, subjective, and involves a complex mix of many important factors. It involves a great many factors, such as whether the delivery went smoothly, whether the baby is healthy and breastfeeding is going well, and the support from hospital staff and family.

A simplified story

However, in Japan today, it seems that the simplification that "if you have an epidural, postpartum will be easy and child-rearing will be easier" has progressed.

On social media, there are many voices saying, "Because it was an epidural, postpartum was easy" or "I was able to walk right away." In fact, those people probably did have an easy time. However, are they not attributing all the good things that happened after childbirth to "the epidural"?

More people are also thinking, "If I have an epidural, my consciousness will be clear, so I can be moved by the birth." Behind this is the image that natural childbirth is too difficult to have the leeway to be moved.

Being able to walk immediately after birth and being deeply moved by the birth are, of course, wonderful experiences. However, these things actually happen in natural childbirth as well. Was that experience really brought about by the anesthesia?

It also depends on the person's own mental and physical state, the progress of the delivery, and luck. The support of family and the involvement of hospital staff, including doctors and midwives, must have also played a large role.

From my experience covering various childbirth facilities, what determines postpartum energy and emotional impact is not whether you chose an epidural. It is how the director, department head, and on-site staff try to support the woman giving birth.Anesthesia is just one option for support, and I feel that the facility's overall philosophy and quality of care matter much more.

The dream of "wanting to give birth with peace of mind" entrusted to anesthesia

I believe the reason epidural births have spread so rapidly is related to the increased anxiety among pregnant women during the COVID-19 pandemic.

In Japan, there have always been quite a few birthing facilities that do not provide midwives, and the response to pain has been lagging.

Then COVID-19 arrived, and support during labor became even thinner. It is said that many of those currently eager for epidurals are women who have given birth before, and when you talk to them, many had the experience of giving birth during the pandemic.

It was a very lonely and painful birth under COVID-19, where husbands could not be present and contact with midwives was kept to a minimum. Childbirth preparation classes, which taught essential self-care techniques like breathing methods and body positioning during labor, were also closed due to COVID-19, leaving many pregnant women thrown into the delivery room alone, completely "unarmed."

That era created many women with a deep fear of labor pain. I think that is why epidural birth shone even brighter and captured the hearts of women who wanted to give birth with some peace of mind. That feeling should be fully acknowledged.

How to achieve an easy and safe birth

What concerns me is that on some birthing facility websites, the information provided about epidural births has become simplified and even fantastical.

Regarding natural birth, spine-chilling and terrifying expressions such as "labor pain is the same as having a finger cut off" are frequently used.

There are also texts that give the impression that feeling labor pain is harmful to the baby.
This seems to be based on the idea that reducing maternal stress can improve placental blood flow and oxygen supply to the fetus. However, on the other hand, epidural anesthesia can also cause maternal hypotension, fever, and changes in fetal heart rate. Therefore, claiming that "epidural birth is better for the baby than natural birth because it causes less stress" is a simplification.

The main advantage of an epidural is simply that an effective analgesic effect can be expected. Regarding the impact on the postpartum period and the baby, other efforts should be made, and the calm judgment of the pregnant woman is required.

It may sound mundane, but whether you choose an epidural or a natural birth, if you want to have the easiest birth possible, an easy postpartum period, and ensure the baby is as safe as possible, there is no choice but to steadily practice moderate exercise, healthy eating, relaxation, and disease prevention.

What I feel is particularly important from my experience in reporting is communication with those who help and are by your side, such as family, doctors, and staff at the birthing facility. No matter how hard you try, you never know what might happen during childbirth. I always feel that for those moments, the most important thing is the power of people.

If you decide you want an epidural after considering that, it has the potential to make your birth even better. The same is true if you choose a natural birth.