by Casey Newman
If you or someone you know is preparing to give birth, you’ve probably done a little research on what will happen during labor and delivery. And if you’re like most people, you probably still have some questions. You’re expecting contractions, pain and pushing, but what about induction, epidurals or snacking during labor? What does the evidence say about some common labor practices?
Here’s an evidence-based look at what you can expect during labor and delivery.
Pain management: Labor can be painful (I say “can” because everyone’s perception of pain is different). And there are a variety of options to help you manage that pain, including:
- Water immersion
- Laughing gas
Benefits and risks of epidurals during labor
Benefits: The main benefit of an epidural, according to Evidence-Based Birth, is it’s considered the most effective form of pain relief. A Cochrane review that looked at 38 different studies, with nearly 10,000 participants found an epidural was effective in lowering pain 3.5 points on the standard 1 to 10 pain scale. In addition to lowering a person’s perception of pain, an epidural can help someone relax and rest if they’ve become exhausted during labor.
Risks: Side effects are the most common risk with an epidural. The Cochrane review found with an epidural, you’re more likely to:
- Need forceps or vacuum delivery, which can cause severe tearing in the perineal area
- Experience low blood pressure, which can require additional IV fluids and make you feel ill
- Have a fever during labor, lose bladder control or have difficulty urinating — this is why there’s usually a catheter inserted during labor if you get an epidural.
- Need Pitocin because an epidural can slow labor
- Have more interventions because an epidural usually comes with continuous monitoring like blood pressure, oxygen levels and fetal monitoring.
Benefits and risks of induction
Benefits: Being induced for medical reasons can help protect the health of you and your baby. Medical reasons for induction can include pre-eclampsia, intrauterine growth restriction and many more. If your provider wants to induce you for a medical reason, they should clearly explain the benefits and risks of the procedure.
Outside of medical reasons for induction, some providers choose to induce a mother because they are close to or past their due date. Other times, mothers may ask for an elective induction for a variety of reasons.
Risks: The ARRIVE study found that in the case of elective inductions, it did not improve outcomes for babies.
Dr. Rebecca Dekker points out that being electively induced at 39 weeks raises your risk of:
- More interventions: continuous fetal monitoring, epidurals, etc.
- Experiencing greater pain from medically induced contractions
- Experiencing excessively frequent contractions
- A potential c-section if your induction fails
- Longer time spent in labor
While there is no evidence of improvement of outcomes for babies for an elective induction at 39 weeks, there may be an improvement of outcomes for babies if a mother is induced at 41 weeks or beyond.
Benefits of being induced at 41 weeks and beyond:
- Lower your risk of stillbirth
- Lower risk of baby needing an intensive care unit admission
- Lower risk of mother developing high blood pressure at the end of pregnancy
- Possible cognitive benefits to babies continuing a pregnancy to 40-41 weeks
The risks of being induced at 41 weeks and beyond are mostly the same as being induced at 39 weeks.
Is there a benefit to going past your due date and waiting for labor to start naturally? Dr. Dekker notes that one of the major benefits of letting things happen naturally is exposure to the hormone shifts that happen during labor. If you’re going past your due date and don’t want to be induced, you should have a conversation with your doctor about the risks and benefits for you.
Benefits and risks of eating and drinking during labor
Labor and delivery is hard work, but if you’re like most pregnant people, you’ve probably been told by a healthcare professional that once you’re in active labor in a hospital, you can’t eat or drink. This is because hospitals are worried about the risk of aspiration if you need to be given general anesthesia.
Benefits: Provides the birthing person with much-needed energy and hydration during labor and delivery. If you’re giving birth in a hospital, you may be hooked to an IV that will hydrate you, but if you choose not to give birth in a hospital, staying hydrated is important. And while some people lose their appetite during labor, some find that eating gives them the needed sustenance to deliver their baby.
Risks: Aspiration from anesthesia if you need a c-section. In 1997, researchers conducted the first large study examining maternal deaths related to anesthesia from 1979 to 1990. What they found was the risk of death due to aspiration from anesthesia during a c-section was 1 in 1.4 million live births.
An interesting note: Dr. Dekker points out that the reason hospitals tell laboring women they can have nothing by mouth is to ensure they have empty stomachs if anesthesia is needed. However, Dr. Dekker notes, stomach emptying slows once someone is in labor. That means that even if you didn’t eat for 24 hours once your contractions started, your stomach may not actually be empty at the time of birth.
No matter what your birth plan includes, be sure to discuss your concerns and desires with your healthcare provider.
Casey Newman is a mother of two from Green who depends on wine to get her through bathtime and bedtime. She is a maternal and women’s health advocate who volunteers with several birth and maternal rights organizations and has spoken to Congress members about issues affecting moms.