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INTRODUCTION

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I’ll admit, I am one of those people who really don’t like medicine. I rarely even take a tylenol. I am sure that was part of the reason I planned for a natural birth. However, it was more than that. I felt like I was a part of this tradition going back to the beginning of time, where women worked to bring their babies into the world. It may sound strange to a lot of people, but I wanted to experience that. So much of our day to day life is depersonalized and cut off from nature, I just wanted to connect to this very real process of bringing forth life and to see what my body was capable of. I will not say labor was fun, but I am so grateful I chose to do it the way I did. I have never felt more powerful than when, after hours and hours of hard work, breathing through contraction after contraction, I lifted that red, beautiful screaming baby up to my chest. I just looked at her and thought, “I did this, I created this.” I really felt like after that, I could do anything. There was no parenting challenge before me that would be too hard. I am sure people have empowering birth experiences other ways as well, but for me the process mattered. It was important. I really felt like I earned my motherhood in that journey.

L. D., new mother

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I would like to avoid an epidural, please don’t offer me one

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Epidural use for pain management in labor has become standard in the United States, with the number of women selecting this option having tripled since the 1980s. In 2011, the CDC reported that 61% of women delivering vaginally had an epidural, however in individual hospitals, that rate may exceed 90%.1 During an epidural, a small catheter is threaded into the epidural space, an area between the bones of the spine and the dura mater that surrounds the spinal cord. Two types of medications, a local anesthetic and a narcotic, are then infused into the epidural space continuously throughout the labor until after delivery, providing pain relief, as well as some degree of numbness and immobility, from the breast line down. Overall, epidurals provide effective pain management for the majority of women, with 88% of women who receive epidurals reporting good pain relief. It also is one of the safest forms of pain relief from the standpoint of the both the baby and mother. Rates of permanent maternal injury related to any form of spinal or neuraxial block is low, at 1.2 per 100,000, while the rate specifically with an epidural is 0.6 in 100,000. While all medications cross the placenta to some degree, the amount of medication that enters maternal circulation and thus reaches the baby is low and, when compared to IV narcotics for pain ...

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