There are many opinions about what is safe or healthy during labor and delivery. This is especially true for women who are attempting a vaginal birth after a Cesarean section (VBAC). Even medical professionals do not always agree on issues such as whether or not epidural blocks are a method of pain management during a VBAC trial of labor.
Risks
Andrea Wingo’s midwife told her that, if she wanted to have a VBAC, she would have to do it naturally. Wingo stated, ” [My midwife] explained to me that an epidural would prolong the labor and can also cause the fetal heart rate to slow …The first sign of uterine rupture is a drop in fetal heart rate. If the hospital doesn’t like the heart rate they will do a [C-section].”
Similarly, the midwife I have seen for three of my four pregnancies, and whom I still see currently, does not push for women to use an epidural during delivery. However, this is true for all vaginal births and not only for VBACs. This is true for the same reasons Wingo’s midwife gave her; epidurals can lower the baby’s heart rate and slow the progression of labor specifically, though other risks and side effects also exist.
Both of these side effects are bad for women who are seeking to deliver via VBAC. As Wingo’s midwife warned her, a drop in fetal heart rate during a VBAC trial of labor is usually interpreted as a sign of fetal distress, and this is cause for an emergency C-section. If labor is not progressing quickly enough, hospitals are prone to push for induction. Unfortunately, drug-induced labor is slightly more likely to result in uterine rupture. Despite these dangers, the benefits may outweigh the risks for some women and healthcare providers.
Christine Fisher’s OB-GYN encouraged an epidural when she delivered her daughter via VBAC. She explained, “He felt it was much safer to do a VBAC with an epidural because of the fact that you could get to the [operating room] must faster.” In order to be prepared for a situation that would require an emergency C-section, Fisher’s doctor felt an epidural would be the best way to go about having a VBAC.
Many women feel that, with the pain control provided by an epidural, they are better able to control when they push. This can make labor easier, and it also may reduce the risk of tearing or needing an episiotomy. In addition, an epidural can lower the mother’s blood pressure. (This is the reason I had an epidural during my first delivery, when I had preeclampsia.)
Ultimately, the choice of whether or not to use an epidural when attempting a VBAC is between the mother and her doctor or midwife. These are just a few of the benefits and risks of doing so. Whatever a woman chooses to do, it is important that she feels she has made an informed decision rather than being coerced or forced into doing something with which she is uncomfortable.
