Running head: EPIDURAL ANALGESIA VERSUS NO ANALGESIA

Epidural Analgesia versus No Analgesia during Vaginal Labor and Delivery

Victoria Simonyakina
Old Dominion University

EPIDURAL ANALGESIA VERSUS NO ANALGESIA

Epidural Analgesia versus No Analgesia during Vaginal Labor and Delivery

For this assignment the student nurse picked one controversial topic related to an
obstetric and womens right issue. The student nurse then explored in-depth the advantages and
disadvantages of each side. The paper is supported with several journal articles, which were used
to supplement the topic, particularly, to provide reasoning and statistics. The goal of the paper
was achieved when the student nurse established the validity of each perspective without
showing personal preference in order to let the audience make an informed decision. Lastly, the
student nurse evaluated the learning process.
Using an epidural analgesia compared to no analgesia approach when giving a vaginal
birth is a continuing debate not only in the United States but in the whole world. Although there
are many advocates of each perspective, the issue remains unsolved for many mothers to be.
While both epidural analgesia and no analgesia approaches have their own advantages and
disadvantages, the decision about pain management is an unquestionable right of each woman.
Nurses are key players in the process because they are not only support and advocate for
womens rights during the birth experience but also provide accurate information to their patients
in order to promote an informed decision.
What Caused and Prompted Past and Present Concern
Historically, pain was considered to be a physiological phenomenon. However, with the
evolving of medicine; pain was reconsidered to be a total body response including mind, body,
and spirit. This significantly influenced the attitude towards pain during labor and delivery.
Before, pain was accepted as a natural response of female body to a birth process. Today, the
decision regarding pain management is a womans right. In fact, many women in the United
Sates choose to have a pain-free birth experience. According to the recent research study, 60% of

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women who give vaginal birth in the United States received epidural analgesia (Greenwell et al.,
2012). This rate is significantly higher in the US than in other developed countries. For example,
in England the epidural rates during vaginal birth are less than 25% and in Japan these rates are
less than 8% (Tamagawa & Weaver, 2012). While choosing a method of pain management is a
right of each woman; not every woman receives enough teaching to make an informed decision.
Very often this choice is influenced by preferences of health care providers. The goal of this
paper is to explore effects of epidural analgesia and no-analgesia approaches on mother and
baby.
Intended Audience
The potential audience are women and/or couples who are pregnant or planning to
become pregnant, their families, obstetric nurses, midwives, and obstetricians. Firstly, according
to the American Nurses Association Code of Ethics, patients have a right for self-determination
(2001). Patients should be made aware that they have a right to make decisions regarding their
own health and, if not offered, should request information to make their decisions informed.
Secondly, health care providers, such as obstetricians and midwives, have an obligation to
explain procedures and possible outcomes and to determine patients understanding. This paper
will be useful for these types of audience as it is intended to provide the results of most recent
research on the chosen issue. Moreover, health care providers have a duty to respect their
patients decisions. Personal preferences of health care providers shouldnt influence womens
decisions.
Lastly, obstetric nurses have an ethical obligation to advocate for patients rights and
empower them regardless the decisions made. Nurses are supposed to verify an understanding of

EPIDURAL ANALGESIA VERSUS NO ANALGESIA

the procedure in case more clarification and teaching is needed. This paper is intended to
reinforce the nursing role in both types of pain management.
Opposing Positions of the Issue
There are a few factors to consider when making a decision between epidural and
unmedicated approaches. These factors are physiological and psychological responses of the
mother and physiological responses of the fetus and, eventually, newborn. The first perspective,
no analgesia, is considered to be a physiologically natural approach. Those who support this
perspective claim that female body was made to give a birth and in low risk pregnancies doesnt
require external procedures to make it happen. However, with the rising of womens right
perspective and improved technology, pain experienced during birth is no longer considered to
be a necessary physiological component of the birth process.
Many women today choose epidural analgesia. Epidural analgesia is given using a
catheter which is inserted into epidural space between dura mater and ligamentum flavum.
Usually combination of local anesthetic agent and opioid is given in epidural analgesia. It results
in decreased sensation of lower part of the body. According the Cochrane review, epidural
analgesia is proven to be an effective pain management method when compared to a placebo or
other pain management techniques (Jones, 2012). However, together with making a birth a more
comfortable process; it increases risks for unwanted side effects. For example, epidural analgesia
causes diminished to absent urge to push. The authors of one study suggest that this can result in
prolonged labor (Hasegawa at al., 2013). However, the authors of a different study claim that it
prolongs labor only when administered early, which is not commonly done in the US today
(Moore, Shan, & Hatzakorzian, 2013). While the possible labor prolongation still remains a
subject of a continuous research, almost all of the found studies agreed that epidural analgesia

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increases risk for instrumental delivery secondary to possible uterine dystonia. According to one
study, vacuum extractions were performed twice more often with epidural analgesia than with
drug-free birth (Hasegawa et al., 2013). Some other adverse effects of epidural analgesia are
difficulty emptying bladder, maternal hypotension, maternal fever, and accidental injection into
spinal cord.
In turn, no-analgesic approach presents fewer side effects and no loss of sensation.
However, together with being able to feel the urge to push, women feel pain to its fullest extent.
As it has been mentioned earlier, pain is a subjective phenomenon and every person experiences
it differently. According to one study, with proper preparation and support women can increase
their satisfaction with the analgesic-free birth experience (Almushait & Abdel Ghani, 2014). Use
of non-pharmacological methods of pain relive enhances positive outcomes of this type of labor.
According to another study, warm showers are a cost effective and a convenient way to pain
reduction during analgesic-free birth (Shu-Ling, Chieh-Yu, Yu-Yin, & Meei-Ling G, 2013). In
fact, in many Asian countries other than pharmacological methods for pain relive are actively
used, such as acupuncture, massage, music, etc. Nursing role is especially important during this
process because nurses have a power to implement non-pharmacological method of pain relief in
the hospital settings. Some women may need reassurance by nurses more than they need drugs.
Pain is a stressful experience. While some women can be prepared for analgesic-free
birth and go through it; it may be harder for other women to control their mind and body. During
stress response catecholamines are released, which increase maternal ventilation and oxygen
consumption leading to fetal hypoxia. It may also prolong labor. This, in turn, can negatively
affect fetal heart rate and variability and increase risk for instrumental delivery. Moreover,

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inability to carry on with the plan after thorough preparation can devastate women. Nurses need
to be especially sensitive to mothers psychological status should this happen.
Generally, women who gave birth with no analgesics tend to feel more empowered. They
report feeling of being in control of their body and ability to use its power instead of fighting it.
However, for some women the tendency is changing. If before natural birth meant giving a birth
without analgesics, now natural birth is associated with giving a birth vaginally regardless of
analgesic use. With both perspectives, women remain alert and actively participate during labor
and delivery.
Effects of epidural and no-analgesic approach on baby should be considered as well.
Epidural medications can cross placenta which may interfere with infants sucking reflex. In
addition, epidural can cause dystonia of uterine muscle leading to possible augmentation with
oxytocin. Exogenous use of oxytocin may decrease endogenous oxytocin. Both of the factors can
interfere with breastfeeding (Dozier et al., 2013).
Unfortunately, often people with low socio-economic status tend to choose nonanalgesics birth for the purpose of reducing the cost of the process. This may result in inadequate
preparation, which may lead to the discussed earlier negative consequences for both mother and
fetus. In addition, these patients generally dont receive prenatal care and teaching. As a result,
they are not educated about pain reducing strategies. Moreover, very often they develop mistrust
to the health care system. According to one study, 37% of studied minorities reported that their
family advised them against epidural analgesia without any scientific evidence (Orejuela, 2012).
Nurses should carefully assess the priorities of these patients while providing culturally
competent care.

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Conclusion
While epidural analgesia is proven to be an effective method of pain relief compared to
non-pharmacological methods during analgesia-free vaginal birth, results of multiple research
studies demonstrate that epidural can cause adverse physiological and psychological effects on
mother and newborn, including increased risk of instrumental delivery. Although, each woman
has a right to decide if she should take a risk; she should be given detailed information about all
possible outcomes. Every woman is different. Thorough assessment of feelings and fears should
be performed. For women who value comfort it may be better to adjust mentally by believing
that giving a birth is already an achievement; while for women who value self-power may be
better to learn ways to control pain using their own mind. In either case, woman should be
provided with information, support, and encouragement. Nursing role is significant in a both
birth processes. Nurses are the ones who inform, advocate, and provide psychological support for
their patients.
Learning Reflection
While the nursing student has an opinion regarding epidural analgesia versus no
analgesia, as a result of a research process the nursing student realized that the opinion was
formed by cultural values. Scientific-based exploration of both sides of the issue was an eyeopening process. In the world where everyone has strong opinions, it is hard to remain objective
about different issues. However, being a nurse means supporting and advocating for patients
regardless ones own preferences.
Exploration of the issue allowed the student to reflect on her moral and spiritual values
concerning womens right during the birth process. It also demonstrated the importance of
continued education in order to remain current with area of interest. It taught the nursing student

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to become a true patient advocate in order to empower women during one of the most
meaningful moments of their lifes.

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References
Almushait, M, & Abdel Ghani, R.A. (2014). Perception toward non-pharmacological strategies
in relieving labor pain: an analytical descriptive study. Journal of Natural Sciences
Research, 4(2), 5-12.
American Nursing Association. (2001). Code of Ethics for Nurses with Interpretive Statements.
Retrieved March 8, 2012, from http://www.nursingworld.org/codeofethics
Dozier, A., Howard, C., Brownell, E., Wissler, R., Glantz, J. J., Ternullo, S., & ... Lawrence, R.
(2013). Labor epidural anesthesia, obstetric factors and breastfeeding cessation. Maternal
& Child Health Journal, 17(4), 689-698. doi:10.1007/s10995-012-1045-4
Hasegawa, J., Farina, A., Turchi, G., Hasegawa, Y., Zanello, M., & Baroncini, S. (2013). Effects
of epidural analgesia on labor length, instrumental delivery, and neonatal short-term
outcome. Journal of Anesthesia, 27(1), 43-47. doi:10.1007/s00540-012-1480-9
Jones, L. (2012). Pain management for women in labour: an overview of systematic reviews.
Journal of Evidence-Based Medicine, 5(2), 101-102. doi:10.1111/j.17565391.2012.01182.x
Moore, A. R., Li Pi Shan, W., & Hatzakorzian, R. (2013). Predicting early epidurals: association
of maternal, labor, and neonatal characteristics with epidural analgesia initiation at a
cervical dilation of 3 cm or less. Local & Regional Anesthesia, 625-29.
doi:10.2147/LRA.S4668
Orejuela, F., Garcia, T., Green, C., Kilpatrick, C., Guzman, S., & Blackwell, S. (2012). Exploring
factors influencing patient request for epidural analgesia on admission to labor and
delivery in a predominantly latino population. Journal of Immigrant & Minority Health,
14(2), 287-291. doi:10.1007/s10903-011-9440-2

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Shu-Ling, L., Chieh-Yu L., Yu-Yin L., & Meei-Ling G. (2013). Efficacy of warm showers on
labor pain and birth experiences during the first labor stage. Association of Womens
Health, Obstetric and Neonatal Nurses, 42, 19-28.
Tamagawa, K., & Weaver, J. (2012). Analyzing adverse effects of epidural analgesia in labour.
British Journal of Midwifery, 20(10), 704-708.

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Honor Code
I pledge to support the Honor System of Old Dominion University. I will refrain from any form of
academic dishonesty or deception, such as cheating or plagiarism. I am aware that as a member of
the academic community, it is my responsibility to turn in all suspected violators of the Honor Code.
I will report to a hearing if summoned.
Signature _________Victoria Simonyakina 04/03/2014_________________________________

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Grading Rubric
CONTENT
A. Introduce the issue: what caused it and
what prompted past and present interest
and concern.
B. Identify who is interested in it and why,
eg., who is your audience?
C. Examine the opposing positions on the
issueto include the usual reasons cited
to establish the validity of each
perspective. Clearly delineate each side.
Summarization to include a reflection of
what you have learned from doing this
paper.

POINTS
POSSIBL
E
15
15

30

D. Minimum of one recent nursing journal

used and a second related journal used for
validation.

20

E. Correct APA format.

10

F. Grammar, spelling and logical transitions.

10

TOTAL POINTS POSSIBLE

100

COMMENTS

POINTS