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The Great Epidural Debate

An epidural can relieve the agony of labor without eliminating the ecstasy of birth. That's why one in three women opt for this method, which delivers medication into a space near the spine to dull labor pain while allowing a mother to remain alert.

But there's controversy associated with this anesthetic: According to several studies, women who have epidurals are much more likely to undergo cesarean sections (and forceps deliveries or vacuum extractions) than women who don't. These findings seem logical because the anesthesia can slow labor and interfere with a woman's ability to push.

Four studies involving more than 22,000 women, however, dispute this link. The results: The rate of c-sections among women who have had epidurals is no higher than among those who've received other forms of pain relief. So what accounts for the studies' association of epidurals with c-sections? Researchers theorize that epidurals are the result rather than the cause of labors that end in surgery. It's not the anesthesia itself that leads to c-sections, they say, but the exceptionally painful nature of these "problem" labors that spurs women to seek epidurals in the first place.

As intriguing as the research is, some experts remain unconvinced. They also caution that epidurals can cause temporary back soreness, "spinal headaches," drops in blood pressure, and slight fevers in women that can result in their newborns being unnecessarily tested for infection. While this debate continues, "the important thing is to be an educated consumer," says Joy Hawkins, M.D., of the American Society of Anesthesiologists. Find out your obstetrician's c-section rate and how he prefers to handle difficult labors, since both of these influence your likelihood of surgery.

"Also ask about the availability of low-dose or 'walking' epidurals, which allow you to retain muscle strength and participate more fully," Hawkins suggests. "Then make your decision based on how your labor is going."