Running Head: EFFECTS OF CHILDBIRTH ON LABOR EXPERIENCE

Effects of Natural Childbirth and Epidural Childbirth on Labor Experience

Emily Marino, Katlyn Hosa, Emily Kurnot, Nylauna Petty, and Sydney Telischak

Youngstown State University

NURS 3749: Nursing Research

Valerie O’Dell

4/15/2020
EFFECTS OF CHILDBIRTH ON LABOR EXPERIENCE 2

Abstract

The purpose of this research was to gather data regarding both natural and epidural

assisted childbirth. The data was compared and analyzed in order to conclude how a mother’s

labor experience was affected by the use or lack of medical interventions. Factors such as

epidural analgesia, pain relief, emotional well-being and complications were explored in relation

to the birth experience. Research found that every factor mentioned should be considered during

pregnancy and birth planning because they all contribute to each other. Regardless of the birth

plan, epidural analgesia is the most commonly used pain relief method in the hospital. Epidural

birth is associated with higher levels of pain satisfaction but results in a higher rate of emotional

disappointment in the mother. Research suggests that a mother that fears pain or has a history of

mental health issues is much more likely to plan to receive an epidural. However, non-

pharmacological measures are increasingly being implemented and incorporated in birth

planning. This is partly due to the complications and risks associated with an epidural. There was

no specific evidence that suggested that either birthing process was more influential or preferred

to the mother. Overall, the research presented to show that each mother’s experience is

individualized and highly subjective. Therefore, a holistic approach should be incorporated into

every birthing process to ensure that the mother and family are satisfied with their planned

birthing choice.

Effects of Natural Childbirth and Epidural Childbirth on Labor Experience

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As the obstetric field of nursing begins to offer and perform more holistic forms of

childbirth, many women remain unsure of their birth plan. Epidurals are commonly administered

during labor and delivery to decrease the amount of pain the woman experiences. However,

many more women are choosing to deliver naturally, with little medical intervention. This has

created discussion among childbearing women and medical professionals. The benefits and risks

of both labor processes have been compared and analyzed. With the many options of childbirth,

women can easily become overwhelmed and conflicted. This creates an opportunity, as nurses, to

provide childbearing women information regarding all of the factors that contribute to childbirth.

Therefore, the following research question was addressed: How does natural childbirth compared

to epidural childbirth affect the mother’s labor experience from birth planning to one month

postpartum?

Literature Review

Introduction

This paper analyzes the factors that contribute to a woman’s labor and birthing

experience. In order to address this controversy, information was gathered from ten different

research articles. These articles collectively review the many factors that contribute to a mother’s

decision between a natural or epidural assisted childbirth. A comparison has been made in order

to respectively review and analyze this issue. The following will be discussed: effects of epidural

childbirth, pain relief, mental and emotional well-being of the mother and complications of

childbirth.

Epidural Childbirth

Epidural childbirth is a common method used to reduce pain associated with labor.

However, pain is only one of the factors that contributes to such a decision. There are negative
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outcomes that may be associated with the use of an epidural. According to Hatamleh et al.,

(2019), epidural analgesia (EA) was proven to have benefits when used appropriately during the

childbirth process. This included “continuing pain relief and allowing the mother to remain alert

during labour, which results in higher maternal engagement and satisfaction” (Hatamleh et al.,

2019, p. 135). Furthermore, the use of an epidural permitted access for any urgent intervention,

such as a cesarean section. When a mother decides to receive an epidural, she needs to be aware

of all of the possible outcomes, including negative ones. A comparative retrospective study was

completed, comparing the outcomes of women who received an EA with those who had no EA.

More than half of the sample (52.2%) received an epidural. The article continues to say, “The

group of women who received an EA had a significantly higher rate of instrumental birth,

prolonged second stage of labour, and higher rates of maternal complications compared with the

group of women who had no EA” (Hatamleh et al., 2019, p. 135). The use of epidurals has both

risks and benefits. Before deciding, the mother and family should be informed of the risks and

receive proper counseling.

Pain Relief

The experience of childbirth is a subjective and multifactorial issue. In regards to pain

relief during labor and delivery, there are many options available. “Labour pain management is

not only a crucial concern for future mothers but also a great challenge in modern medicine”

(Czech et al., 2018, p.2). This challenge persists because of the increasing opinions and

confusion regarding the birth plan of each mother. The childbirth experience includes much more

than pain. However, many individuals tend to focus on alleviating the fear of physical

discomfort. In this comparative study, six methods of pain relief were compared based on

maternal satisfaction and pain relief: epidural anesthesia, water immersion and water birth,
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nitrous oxide gas for pain control, transcutaneous electrical nerve stimulation (TENS), multiple

management and none (Czech et al., p. 1). According to the study, epidural analgesia is still the

most effective and recommended method of pain relief. However, women are still concerned

about the complications, regardless of the low incident rates. Water immersion remained the

most acceptable non-pharmacological pain relief method. (Czech et al). This provides data to

suggest that a mother can be satisfied and report decreased pain levels regardless of the level of

medical intervention. It is important to understand that each woman’s pain threshold is different,

along with their pain expectation. Along with pain relief, the care provided during the

antepartum period contributes to the mother’s satisfaction level and overall experience.

The degree of pain felt by a laboring mother is an individual and unique experience based

on the mother’s perception of pain, and her attitude entering into childbirth. When a childbearing

woman fears the aspect of pain in which she will experience during her personal laboring

progression she may be more subject to put emphasis on pain more than a laboring mother who

is accepting of pain as a natural dynamic in labor. Globally, there are many options available to

address this fear that women have when approaching the big day, of birthing their child. These

options include pharmacological measures such as epidurals and opioid analgesia or non-

pharmacological measures such as relaxation, massage techniques. The most common relief

measure that childbearing women include in their birth plan is the use of an epidural analgesia, it

is considered to be an effective form of pain relief. In a comparative study between

pharmacological and non-pharmacological pain relief methods conducted by the World Health

Organization, referenced by Thomson, Feeley, Moran, Downe and Oladapo (2019) the use of the

epidural comes with increased risk, “…it is not necessarily associated with a positive experience

of birth. In addition, this form of pain relief is expensive, can decrease a woman's feeling of
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control, delay the second stage of labor and increase likelihood of further interventions...” (p. 2).

A key difference between the two methods is how they directed the women’s attention, focus and

capabilities in relation to pushing, decision making, and interaction with/support from the health

care providers. The correlation between labor encouragement and decreased labor pain was

evident in the study, poor caregiver support could be a factor in unanticipated need for

pharmacological pain relief, with a strong relation to later feelings of failure and guilt. Thomson

et. al., (2019) found the following:

In Morris and Schulman’s study they report how women from an ethnic minority

background and low education were more likely to experience ‘pressure’ from clinicians

to receive an EA… studies reported how standard, traditional prenatal classes focused on

or promoted medication. (p. 14).

Receiving an epidural ultimately gives the HCP more control over the labor because the mother

becomes drowsy and numb, therefore an epidural is the method of choice by many in healthcare,

making the others who choose to not go the EA route feel out of place.

Postpartum depression is a common disorder among postpartum women and is

manipulated by many factors. According to Barooti, Malek, Honarmand, Moshari and

Alshohadaei (2019), “…studies have pointed out that one of the major factors influencing the

likelihood of the onset and severity of depression is the amount of pain the mother experiences

during childbirth” (p. 354). A positive labor experience includes satisfaction of birth planning

until postpartum. This shows that the choice for pain relief will continue to affect the mother

even into the postpartum phase, and will influence the decisions being made in regard to pain

relief with future deliveries.

Emotional well-being
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There are many different factors that must be considered when looking at emotional well-

being in relation to receiving an epidural or having a natural birth. It’s important to remember

emotions are experienced differently by everyone. Any pre-existing psychological disorders, use

of birth education programs, having an emotional support person and the number of prior births

affects the woman’s mental status during and after the birthing experience. One study stated,

“We found that women with fear of childbirth would choose EDA, whereas women who

participated in labour preparation courses would rather consider other methods for pain relief

during labour” (Sitras et al., 2017, p. 9). In this study, it went into deeper detail to describe how

these labor preparation courses have changed. It stated that in 1999, women who took these

courses were more likely to receive an epidural rather than using other methods of pain relief.

When this study was conducted in 2005, women who took these courses would rather choose a

different method of pain relief. The courses now focus on education of physiology of labor and

childbirth, benefits and risks to pain relief methods, and emphasize that labor pain is temporary

(Sitras et al., 2017, p. 10). The next aspect to consider is mental health and parity, “...multiparous

women with mental health problems had 65% higher odds for choosing EDA during labour

compared to multiparous women without mental health problems” (Sitras et al., 2017 p. 8).

Another study, by Lindholm and Hildingsson, conducted in 2015 had similar results in relation to

parity. They found that, “Multiparous women were, on the other hand, less likely to prefer non-

pharmacological managements compared to primiparas” (Lindholm & Hidingsson, 2015, p. 6).

They attributed this to recollection of extensive pain in prior labor experience. The last aspect to

discuss is the use of an emotional support person. According to Lindholm and Hildingsson

(2015), the presence of a support person is only effective for pain relief if the woman has a

trustful relationship with them. Overall, both studies came to the conclusion that the use of an
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epidural leads to negative emotional experiences related to birth. One study explicitly stated,

“Epidural analgesia was associated with a less positive birth experience, with and without

preferences” (Lindholm & Hidingsson, 2015, p. 7). A few possible reasons are that women who

fear pain of childbirth are usually offered early epidurals, and the use of an epidural makes the

woman feel out of control which is linked to a negative birth experience (Lindholm &

Hidingsson, 2015, p. 7).

Complications

The experience of childbirth is different for all women, and when it comes to the

complications associated with childbirth, it is a possibility that a woman, and even the neonate,

can experience life-threatening complications. Intrapartum and postpartum complications can be

a result of a natural or epidural assisted childbirth. When undergoing childbirth, it is imperative

that the mother is aware of these complications.

Many experiments have been conducted and there are a variety of complications that can

occur. As a result of a mother receiving epidural analgesia to assist in childbirth, "Trials of

delayed pushing have occured" (Anwar et al, 2015, p. 1). This is due to the mother's weak desire

to actually push, which can put the mother and neonate at a higher risk for potential

complications. As a result of receiving epidural analgesia, a reduction in certain reflexes occurs.

"Other maternal outcomes include second stage caesarean section, episiotomy, perineal injuries,

maternal fever, partial block, post-dural puncture headache, urinary retention and hypotension"

(Anwar et al, 2015, p. 2). These complications can be a result of natural childbirth or receiving

epidural analgesia, which can be related to a negative birth and postpartum experience, and can

affect the neonate as well.

EFFECTS OF CHILDBIRTH ON LABOR EXPERIENCE 9

In being aware of the possibility of these complications occurring, the use of epidural

analgesia to assist with childbirth is steadily increasing, simply because epidural analgesia, as

harmful as it can be, serves as an effective method of pain relief during labour. After extensive

research between two experimental groups, “Complications were defined as hypotension,

unilateral block, unblocked segments, post-dural puncture headache, cardiac arrest, etc” (Anwar

et al, 2015, p. 2). These complications were most likely to occur if the analgesia wasn’t adequate

and reassessment and removal had to occur. The study found “Four patients out of 100 had

intrapartum complications” (Anwar et al, 2015, p. 3). The women that experienced these

complications received epidural analgesia, while “No intrapartum complications were observed

in the non-epidural group” (Anwar et al, 2015, p. 3). This proves that, even though there is a

general risk of childbirth, women who receive epidural to relieve pain, are at a higher risk for

experiencing intrapartum complications.

Aside from general complications, we found extensive research in regards to neurological

complications and injuries that result from lumbar and cervical dural punctures, primarily

epidural injections during labor and delivery. Studies show, "Inadvertent lumbar dural punctures

led to multiple neurological complications including intracranial hypotension, subdural

hematomas, and double vision/6th cranial nerve palsies" (Epstein, 2017, p. 1). The possible

outcome from receiving epidural proves it is imperative to assess and consider these adverse

complications and risks before administering to a child bearing woman, whether the

complications are short-term or long-term. The study also showed that after going through labor,

signs and symptoms of complications were present, some taking up to 14 days to present. Four

patients received epidural spinal injections for labor/delivery. Two women exhibited intracranial

hypotension and two women exhibited postural headaches. Two women who exhibited postural
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headaches, presented with additional complications postpartum, and one case required additional

surgery in relation to the complication. Although epidural analgesia is effective in reducing pain,

it is imperative that our patients and healthcare providers are educated about the potential

complications and outcomes that may present intrapartum or postpartum.

Labor is an extremely painful experience for a woman to go through. Fortunately, women

have the choice between using epidural anesthesia or having a natural childbirth. The question of

whether epidural analgesia is a safe option remains unanswered and has become a controversial

topic. Studies have tried to prove that epidural analgesia has major complications for women

during labor and in the postpartum stage. According to Söderholm (2018) the use of epidural

analgesia was proven to cause unwanted complications in mothers and neonates. This included

“...increases in labor duration, rate of instrumental deliveries, oxytocin use, temperature, and risk

of fetal malrotation” (Söderholm, p. 768). The stage of active labor is when the woman is

actively pushing to deliver the baby and the duration of the stage varies between natural

childbirth and epidural analgesia assisted childbirth. According to Söderholm (2018) the active

labor stage for the epidural analgesia group was 118 minutes longer than those in the natural

childbirth group. This result proved that epidural analgesia slows the birthing processing which

can result in the patient needing a cesarean section.

Amount of blood loss is a worrisome complication in childbirth. Söderholm’s (2018)

study also looked at differences in total bleeding volume between non-epidural analgesia users

and epidural analgesia users. “Total bleeding volume was higher in the EDA (epidural analgesia)

group compared with the non-EDA (epidural analgesia) group, but the difference was not

significant after adjusting for gestational age” (Söderholm, p. 771). This study still shows a
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significant difference in total bleeding volumes. According to Söderholm (2018) Those who use

epidural analgesia have slower active labor as well as higher bleeding volumes which shows that

epidural may make the uterus contract less which can be fatal. “…the risk of postpartum

hemorrhage doubled when epidural analgesia was used, and the risk remained even after

correction for multiple maternal – and pregnancy- related factors” (Söderholm, p. 774).

Postpartum hemorrhage is a fatal complication of labor that can harm the mother as well as the

neonate.

As previously stated, epidural analgesia runs the risk of slowing labor. “In the present

series, the most frequent reason a woman had an instrumental delivery was for stalled labor,

followed by risk to fetal well-being” (Herrera-Gómez, p. 848). An instrumental delivery includes

the use of forceps and vacuum assisted deliveries. They are used to help babies move along the

birth canal to be delivered. “…the mothers receiving EA (epidural analgesia) in the present study

were more likely to undergo an episiotomy, which may be in part related to a slowing of the

labor process and the need for an instrumental delivery” (Herrera-Gómez, p. 848). Episiotomies

also run the risk of a longer recovery time for the mothers, as well as cesarean sections (Herrera-

Gómez, p. 848).

Hormones play a big role in the labor process. “EA administration during labor process

interferes with the main hormones involved in labor, reducing the secretion of oxytocin,

prostaglandin-F2α, β-endorphin, and inflammatory cytokines (Handlin et al., 2009; Mantha,

Vallejo, Ramesh, Jones, & Ramanathan, 2012, as cited in Herrera-Gómez, p. 842) . A woman

who decides to use epidural analgesia is also at risk for other complications such as urinary
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retention, fever, hypotension, and instrumental or cesarean deliveries (Herrera-Gómez, p. 842).

Cesarean deliveries are usually not part of an expecting mothers birthing plan, but an epidural

may be part of their plan. “It is important for nurses and midwives to have the greatest possible

information on the areas where there may be some risk and on the level of that risk” (Herrera-

Gómez, p. 849). It is shown that epidural analgesia has many undesired effects on the human

body, many that women may not know about or understand. In this study it is suggested that

health care providers need to look at the use of epidural analgesia in a case by case scenario.

Conclusion

Research was conducted to analyze how natural childbirth compared with epidural

childbirth affects the mother’s postpartum experience from birth planning to four weeks

postpartum. After extensive research, analyzing, and comparison from 10 different studies, the

effects of childbirth in regards to a woman’s physical, emotional, and mental well-being can be

rewarding and beneficial, with the possibility of complications and risks that can contribute to a

negative birth experience. Studies provided evidence that epidural analgesia is the most

commonly used and recommended method during childbirth. Many of the childbearing women

who refuse an epidural fear the complications and potential side effects. Overall, the use of an

epidural leads to higher satisfaction with pain relief, but accounts for lower self-esteem in the

mother. The perception of pain is unique and individualized, as is the opinion of how effective

each pain relief method can be. Studies have shown that the mothers experience of pain

throughout the birthing process not only affects childbirth but the development of postpartum

depression. It is also shown that fear of pain plays a big factor in choosing to receive an epidural.

Communicating with a healthcare provider in regards to each individual birth plan ensures the

best delivery and post-delivery experience. Addressing complications, studies have found that it
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is very rare for women to experience complications who receive epidural analgesia. Even though

women who receive it are at a higher risk for experiencing complications, it does not limit

women who undergo a natural childbirth to experiencing complications. Limiting pain and a

longer active stage of labor are the most significant differences in women who receive epidural

analgesia compared to women who do not. There is little data in regards to choosing a particular

birth plan based on evidence. The country that the studies were conducted in also acts as a

limitation due to the fact that emotions and pain are affected by culture. The efficiency and

satisfaction of any labor and birth experience relies on the mother’s emotional stability, support

system and communication with health care professionals.

References

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analgesia on labor and its outcomes. Journal of Ayub Medical College Abbottabad-

Pakistan. 27 (1) 146-150. http://jamc.ayubmed.edu.pk/index.php/jamc/article/view/1090

Barooti, E., Malek, B., Honarmand, S., Moshari, M., & S. M., S. A. (2019). Investigating the

association of regional anesthesia during labor with postpartum depression. Anaesthesia,

Pain & Intensive Care, 23(4), 353–359.

Czech, I., Fuchs, P., Fuchs, A., Lorek, M., Tobolska-Lorek, D., Drosdzol-Cop, A., &

Sikora, J. (2018). Pharmacological and Non-Pharmacological Methods of Labour Pain

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Epstein, NE. (2017) Neurological complications of lumbar and cervical dural punctures

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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5421209/

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