Epidural- Less Pain In Labor & During Birth With an Epidural. What an OB/GYN Wants You to Know. -with Dr. Tami Michele


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(with Dr. Tami Michele, mama of 4 ,OB/GYN- former doula & childbirth educator) An Epidural helps you have less pain in labor & during birth … who doesn’t want that?

I knew I didn’t want any more labor pain than what was absolutely necessary to have a baby & healthy birth. So I did what most of us would do … I read about an epidural, I asked my friends about their epidural & asked my birth class instructor “What do you think about an epidural?” I never heard anything that helped me make my own decision about getting an epidural. 

Then it hit me like a ton of bricks.

“Why am I charging ahead towards an epidural, without knowing exactly what I’m charging towards?”

If your car was in the shop and they called your cell phone suggesting “you really should think about getting this repair” … what would most of us do? We’d ask questions like “why?” Followed closely by “What can I expect to happen if I get that?”, What happens if I don’t get that?”, What are the potential downsides?”, “What are the benefits?”, “What else changes or happens if I get that?”, “What are my other options?”.

If we ask questions about our car, why wouldn’t we ask those same questions about getting an epidural during birth?

Why aren’t we taught the straight forward benefits & risks of an epidural in labor & during birth. 

Getting informed helps you be confident in your decisions in labor, during birth & after birth (whatever decisions you decide are best for you). Dr. Tami Michele teaches you about an epidural- what they are, what they do (or don’t do) & when in the laboring process women can/should get them.  

Dr. Michele suggests getting labor solidly established before an epidural. If you want to have a faster & less painful birth, then definitely listen to this one.  And you may be surprised to learn that having an epidural takes a bit more planning on your end. Find out why and  you’ll be better prepared and kick any fear you have to the curb mama!

There’s no one right way to birth a baby, but there’s a way that’s right for you.  Listen so you can decide if epidurals are up your alley or not. 

You’ll Also Learn:

  1. What happens & what to expect with an epidural (how it’s done)
  2. What are the risks with an epidural- to mama & baby (the answer will surprise you.)
  3. Why getting  an epidural could increase the chances of a c-section – Dr. Michele explains.
  4. Dr. Michele gives very useful advice & tips for mamas who’ve decided an epidural is the route they want to go. 

Who is Dr. Tami Michele

Dr. Tami Michele is the mama of 4 kiddos.  She was a doula (for 13 years), then become a childbirth educator, then became an OB/GYN. Dr. Michele currently lives and practices in Fremont, Michigan. She has a unique “birth perspective” that many doctors, nurses & other professionals clamor to learn from. Dr. Tami Michele is the real deal.  

Click here to Listen to the Class



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Dr.Tami Michele-The Good, The Bad & The Ugly about Epidurals.

Learn what an OB/Gyn, doula & childbirth educator {all same person} wants you to know.



Sarah Blight:               Hi, this is Sarah Blight with your Baby Booty Interviews where we cut through the fluff and give you the information that you really need to do know and want to know about becoming a mom.


                                    So what’s the scoop on epidurals? Well today, we are chatting with Dr. Tammy Michele. She is a mama of four kids. She was a doula for 13 years and a Bradley childbirth educator before becoming an OB/GYN and she currently lives in Freemont, Michigan. Thank you, Dr. Michele, for being with us today.


Dr. Tami Michele:       Thank you.


Sarah Blight:               So what’s the one thing that you wish you would have known about becoming a mom when you were pregnant with your first?


Dr. Tami Michele:       I wish I would have known who to go to for information and I wish I would have had the information to get me through my labor. I didn’t know anything about doulas. My husband didn’t know how to help me. My first labor all I did was scream to anybody that would come in the room of please help me.


Sarah Blight:               [Laughs]


Dr. Tami Michele:       Even the cleaning lady, I begged her to help me. [Laughs]


Sarah Blight:               [Laughs] Oh, yeah.


Dr. Tami Michele:       After that experience was all over, the second time I thought well with them giving me medication and medically managing my labor, that didn’t work so I turned to natural childbirth and found out how to help myself.


Sarah Blight:               Wow. Okay, for your first birth, that was with medication. You had an epidural?


Dr. Tami Michele:       I did not have an epidural. In fact, the hospital didn’t have epidurals at that time.


Sarah Blight:               Wow.


Dr. Tami Michele:       That was quite a few years ago. But they kept giving me shots, you know, more and more narcotic type medications.


Sarah Blight:               Okay.


Dr. Tami Michele:       It just made me very disoriented and tired and not connected to my body or the birth process. I felt like I walked into the hospital and turned myself over to the staff, the nurses and the doctors and had the attitude of do what you can to get the baby out. So for me going from that experience to a natural birth experience and learning how to work with contractions and just stay relaxed during the process and enjoy it, it was a huge change.


Sarah Blight:               Wow. That sounds like a whole another interview. [Laughs] I think I would like to pick your brain on that one. That’s really cool [Laughs]


Dr. Tami Michele:       Yeah. I guess my point is that women can do it with an epidural, but it takes some planning.


Sarah Blight:               Uh-hum. Okay. That’s a good point and I want to get to that in a minute. Let’s start off with can you just explain to us how epidurals are done? For someone who’s like, yeah, I want an epidural or I’m thinking about it, what actually happens? When a mom requests an epidural, what usually occurs?


Dr. Tami Michele:       Well an epidural is placed in the lower lumbar back area so the lower back and it’s using a needle to go to the epidural space, which is just outside the spinal cord. Some numbing medication and some narcotic medication both are injected into that space and it affects the nerves over the area where she’s feeling contractions so the lower abdomen. It can also cause numbness from the rib area down.


Sarah Blight:               Uh-hum. Okay. Okay. So the anesthesiologist comes in. Is there anything else after he injects the numbing — what does he do after he/she, after they inject the numbing meds? Is there actually something that — I’m guessing there’s something that stays in your back. Does it stay in your back, is there a port or –


Dr. Tami Michele:       Yes.


Sarah Blight:               — how does that –


Dr. Tami Michele:       It’s a catheter, it’s a little plastic catheter–


Sarah Blight:               Okay.


Dr. Tami Michele:       — that is placed into the epidural space with a continues flow of –


Sarah Blight:               Okay.


Dr. Tami Michele:       — of this medication. The medication is on a monitor pump.


Sarah Blight:               Oh, okay.


Dr. Tami Michele:       Some epidurals have a PCA, that’s called a patient-controlled anesthesia where the woman can hit the button –


Sarah Blight:               Oh, okay.


Dr. Tami Michele:       — and get another larger dose infusing into the spinal area–


Sarah Blight:               Okay.


Dr. Tami Michele:       — to continue the pain management process. There’s also a lot of monitoring that has to go on too.


Sarah Blight:               Okay. So you can tell us about that. Why do they need to monitor and what do you mean by more monitoring?


Dr. Tami Michele:       Well, the biggest risk for the mother with an epidural is called a high spinal bock where the numbing medication goes up high enough that it could start to numb the respiratory or heart muscle.


Sarah Blight:               Okay.


Dr. Tami Michele:       And if that were to occur, it would be an emergent situation that could even lead to resuscitation type things if her heart were to stop.



Sarah Blight:               Okay.


Dr. Tami Michele:       So there’s continuous monitoring that has to go on after the medication is administered of her heart rate, her breathing, her pulse and of the baby also to make sure the baby is tolerating the medication well.


Sarah Blight:               Okay, what if you have to go to the bathroom and you have an epidural, how do you do that?


Dr. Tami Michele:       Well many women can’t feel their bladder anymore, they can’t feel an urge to empty their bladder.


Sarah Blight:               Uh-hum.


Dr. Tami Michele:       So they have to try to use a bedpan. If they can’t empty their bladder, then a catheter needs to be inserted inside the bladder. It is important of course to keep the bladder empty during the labor process so that the baby can move down. A full bladder can hold the baby from descending into the pelvis.


Sarah Blight:               Oh, yeah, that’s a good point. I never even had thought about that so okay. So you may have to have a catheter, is that called like a urinary catheter something to make sure you can go to the bathroom.


Dr. Tami Michele:       Right.


Sarah Blight:               Okay. When can women typically get an epidural? Of course, we all share stories and one woman says well they told me I couldn’t have an epidural at this point or, you know. Is there a general timeframe when a woman can request or can’t request to have an epidural if they choose to go that route?


Dr. Tami Michele:       We don’t like to give epidurals too early because one of the side effects of epidurals is it can make labor slow down, less effective. Labor can actually stop after an epidural in some people. So we always want to make sure the labor is well established and she’s advancing in dilation before she requests and epidural to be put in.


Sarah Blight:               Uh-hum. Okay.


Dr. Tami Michele:       Often after an epidural is put in if the labor slows down, she will need some pitocin to cause stronger contractions to speed up the labor again to get her back on track. Sometimes that doesn’t even help. Sometimes there is –


Sarah Blight:               Okay.


Dr. Tami Michele:       — a failure to progress after an epidural so that would be why doctors suggest that they don’t have it placed too early.


Sarah Blight:               Okay. Is there a too late scenario? I mean obviously if the baby is crowning it would be too late, but is there a scenario when it’s just — or is it just a matter of timing if the anesthesiologist is available?


Dr. Tami Michele:       Well sometimes it’s timing in the hospitals how quickly the anesthesiologist can get there. But generally the epidural covers the nerves that affect contractions so more of the uterine–


Sarah Blight:               Uh-hum.


Dr. Tami Michele:       When the baby descends through the pelvis down on to pelvic floor through the vaginal canal, those muscles and nerves are not covered as well by the epidural so the women often start to feel a little more sensation or discomfort as the baby is coming down.


Sarah Blight:               Uh-hum.


Dr. Tami Michele:       So once you get to that point, it’s best just to push the baby out rather than try to get an epidural. It’s not going to be as effective plus you’re taking on all the extra risks.


Sarah Blight:               Right.


Dr. Tami Michele:       And pushing is not as effective with an epidural. It takes a long time and you lose your strength because you can’t feel what you’re doing.


Sarah Blight:               Uh-hum. Yeah, I was going to ask you about that, you know, women who give birth naturally often say that they experienced this uncontrollable urge to push. You know, I mean there was nothing that was going to stop them from pushing at that moment. This is something I’m curious about, do women who have an epidural, does their body still have that urge to push or does their body lose that urge? I mean I’m guessing they don’t necessarily feel that urge themselves, but is their body still trying to send that signal or what’s going on with that?


Dr. Tami Michele:       The uterus will still contract.


Sarah Blight:               Uh-hum.


Dr. Tami Michele:       Sometimes it gets less effective like I just said, but the uterus still contracts and many women describe as the baby moves down that they feel pressure or rectal pressure.


Sarah Blight:               Uh-hum. Uh-hum.


Dr. Tami Michele:       Such as that they have to have a bowel movement and that’s one of the things that help the physician and the nurse to know that she is moving towards the pushing stage.


Sarah Blight:               Okay.


Dr. Tami Michele:       So there is some sensation that you feel, it’s just that it’s not as strong so it’s harder to work with the body when you have an epidural.


Sarah Blight:               Okay. So let’s talk for a second about risk. When you have a mama who comes into you and says I’m considering having an epidural, what do you go over? What risks do you kind of go over with her, for mama and for baby?


Dr. Tami Michele:       Uh-hum. Well for the mother, we had talked about the high spinal block that could paralyze the breathing or heart muscle. You could also — you know, and with that, it would be like a cardiac arrest type thing that could need a resuscitation, it could seizures, strokes or death.



Sarah Blight:               Okay.


Dr. Tami Michele:       Before anyone chooses an epidural, we make sure that they are aware of these risks. The best time to talk about risk is not when they’re in labor.


Sarah Blight:               Yeah.


Dr. Tami Michele:       I would like to cover all these things with women during the pregnancy. I use one of the prenatal visits to just cover epidurals and go through the consent form to make sure they understand the risk before they’re even in the labor situation and to know what alternatives they have for dealing with labor discomfort. The risk to the baby and I have to say there is more risk to the baby than there is to the mother. The risk to the baby is –


Sarah Blight:               Really?


Dr. Tami Michele:       — much more common than the risk to the mother.


Sarah Blight:               Really?


Dr. Tami Michele:       Yes. And this has to do with one of the side effects of an epidural that when the medication is put in, it can cause the mother’s blood pressure to drop extremely low. When the blood pressure drops, the body is not pumping the blood and oxygen through the placenta and through the cord to the baby as well and the baby on the monitor can show signs of fetal distress. The baby’s heart rate will drop very low and there are some emergency things that doctors and nurses have in place to try to reestablish that baby’s heart rate, get it back up and that has to do with giving the mother oxygen, changing her position, giving her some more IV fluids and things like that. If we cannot get the baby’s heart rate to come back up, it leads to an emergency C-section.


Sarah Blight:               Okay.


Dr. Tami Michele:       Often that is a direct result of the epidural.


Sarah Blight:               Okay. That’s going to be one of my other questions.


Dr. Tami Michele:       Okay.


Sarah Blight:               Yeah. But I want to stay on the risks to the baby are higher because that surprises me, I think that might surprise a lot of women to hear that. What other risks are there to baby?


Dr. Tami Michele:       Well, with the heart rate dropping we have the risk of fetal distress brain damage or death. And I also have to say that there is an effect on breastfeeding and that some babies due to the medications that are in the epidural don’t nurse well for the first 12 to 72 hours in epidural deliveries. So that is something to take in consideration also.


Sarah Blight:               Why is that? Is it because — are the babies actually getting some of that medicine in their system as well?


Dr. Tami Michele:       Yes, they are. Yes.


Sarah Blight:               Uh-hum. And what effect does usually have — you said breastfeeding kind of issues, is it — what are you seeing with newborns who — you know, a lot of people you hear say well my baby was really alert and really whatever is that — is typically you see the babies are sleepier or just a little bit more –


Dr. Tami Michele:       Yeah, they’re sleepier. They’re just not interested in nursing and the most critical time to establish breastfeeding is during the first two days. So if the breastfeeding initiation is delayed, it does not get off to a very good start, babies are then given bottles of formula and the whole breastfeeding situation is at risk then. Many mothers –


Sarah Blight:               Okay.


Dr. Tami Michele:       — at that point.


Sarah Blight:               Okay.


Dr. Tami Michele:       Another risk too is a side effect of the epidural can cause the mother’s temperature to go up and when her temperature goes up, the baby’s heart rate also goes up and it’s very difficult for the doctor to tell if the temperature is up because it’s a sign of developing infection or a side effect of the epidural. So women and babies have to be treated as though they are developing an infection. They may be given additional antibiotics, blood tests, IV medications.


Sarah Blight:               Okay.


Dr. Tami Michele:       And the babies are monitored for infections with more blood draws and things like that. So that’s another thing that can happen.


Sarah Blight:               Okay. How many women get pain relief from epidurals?


Dr. Tami Michele:       Well it depends on where they are giving birth. Some hospitals it’s as high as 90% or more and at some hospitals the particular one that I work for it varies by month but sometimes we have an 18% epidural rate, sometimes we have a 30% epidural rate.



Sarah Blight:               Interesting. So women who give — oh, I already asked that question. Do women and we talked a little bit about this women typically who have epidurals have more problems pushing. I found and I did not have an epidural, but I have found pushing to be difficult and that’s when I could feel it. [Laughs]


Dr. Tami Michele:       Yes.


Sarah Blight:               So is there a way for a woman who maybe says I really want to have an epidural, but I really do want to feel and be able to push, is there some way where she can kind of have the best of both worlds?


Dr. Tami Michele:       In that case, we often turn it down or turn it off when we get to the pushing stage. And as far as the contractions, the contractions usually feel better when women are pushing than they did during that time of dilation from about 7 to 10 cm.


Sarah Blight:               Uh-hum.


Dr. Tami Michele:       So it’s the whole shift in how they’re dealing with their pain. Often if I can get the women through that final bit of labor, pushing is so much better and then they realize they didn’t need the epidural after all.


Sarah Blight:               Uh-hum. So you said a little — you kind of briefly mentioned this, but are women who get an epidural more likely to end up having a C-section? Do you see kind of links between those two or is it mainly we’ve heard a lot about in the press and in the news about, you know, induction and inductions are linked to C-sections. So it is epidural use also?


Dr. Tami Michele:       Well oftentimes, the baby gets into the wrong position, meaning that — well in a normal labor, we like to have the baby’s face pointed towards the mother’s spine as it’s coming through the pelvis and then the head navigates through the pelvic bones and that’s the way that it fits the best. If the baby is in a posterior position, that means they’re looking more up away from the mother’s spine and they just don’t fit through the pelvis as well.


Sarah Blight:               Uh-hum.


Dr. Tami Michele:       So pushing is longer, it takes a lot of position changes when the baby is positioned like that to get the baby to navigate through the pelvic bones. When the woman has an epidural, she can’t work with the baby in the positioning to get the baby to turn. So that’s where we run into trouble.


Sarah Blight:               Okay.


Dr. Tami Michele:       The babies get lodged in there and we can’t get them out. Sometimes they can push them down far enough that they can be delivered with forceps or a vacuum. Those also have risks and can damage some of the mother’s tissue. So yes, that’s how it leads to more C-sections.


Sarah Blight:               Okay. Okay. Is there data on that or I’m guessing there’s got to be research somewhere on the link or on the that, the epidural, C-section link.


Dr. Tami Michele:       Well there is but I can’t –


Sarah Blight:               Okay.


Dr. Tami Michele:       Off the top of my head I don’t have it.


Sarah Blight:               Yes. That’s okay. If the mom has definitely decided to get an epidural, what advice or recommendations do you have for her? You said at the beginning it takes more planning. Can you explain that more and tell us what that kind of looks like for a mom or what that might look like for a mom.


Dr. Tami Michele:       Well if she is planning to have an epidural, my first bit of advice would be to have labor well established. Make sure she’s moving along in labor that she’s having adequate contractions, that the baby is in a good position. I often will use my bedside ultrasound real quick just to make sure the baby is positioned good so that it won’t get lodged into that wrong position after the epidural.


Sarah Blight:               Okay.


Dr. Tami Michele:       I ask the moms to try other positions first, getting up, moving around, hands on knees to maximize the chance that the baby is positioned well. I think that’s the key.


Sarah Blight:               Okay. And is there any other advice you have, things that you would recommend they do before they even go into labor to prepare for an epidural? I think some women might be surprised to know that they will experience pain even if they decide to go with the epidural and that could be because, you know, of what you said recommending your labor is well established or maybe the anesthesiologist is in a C-section and can’t get to them for a while. [Laughs]



Dr. Tami Michele:       We always have–


Sarah Blight:               What do you –


Dr. Tami Michele:       — the backup plan.


Sarah Blight:               Yeah. [Laughs]


Dr. Tami Michele:       Don’t cheat yourself by saying I don’t need my childbirth education classes because I’m going to have an epidural and everything will be fine. You always need a backup plan. Some epidurals don’t work, the anesthesiologist will put it in and might only work on one side and I don’t know what it’s like to have contractions on one side of your body, but the women tell me that it’s horrible.


Sarah Blight:               Uh-hum.


Dr. Tami Michele:       And then if things aren’t progressing or they’re not able to push the babies out and the epidural needs to be turned off, they have to have an idea of different pushing positions or…


Sarah Blight:               Uh-hum.


Dr. Tami Michele:       And this all comes down to the education. You still need to be educated on normal birth without an epidural so that you would know what to do in case.


Sarah Blight:               Do you recommend doulas for women who are planning on having an epidural?


Dr. Tami Michele:       Oh, I would still absolutely recommend a doula. The woman maybe surprised that when she’s in her labor pattern, that it’s working so well and she’s staying relaxed and labor is progressing. She might change her plan and decide not to have an epidural. But even with an epidural, it’s still nice to have that person that’s knowledgeable, that’s not responsible for your medical care, that can stand at your bedside, keep you relaxed and keep you focused on what you’re doing and still understanding the procedures that are going on with the epidural. It’s just so valuable.


Sarah Blight:               Awesome. Well we’re going to end on that note. So all the mamas who are listening, if you have any comments or experiences you’d like to share about epidurals or questions, please leave them below. I will put the links to some of the information that we talked about underneath this interview. Thanks so much to Dr. Michele for sharing your expertise with us today. We really appreciate having you here.

 Dr. Tami Michele:       You’re welcome.

 Sarah Blight:               We will see you guys soon. Thanks mamas for listening.

 [0:22:32]                      End of Audio


  • Bethany Hays

    A couple of comments: There is no point during labor at which you cannot get an epidural if you are able to get into the position the anesthesiologist prefers (and is best at getting the needle in the right place. Some nurses know that when the mother wants an epidural it is often a sign that she is about to deliver and they will talk her out of it by saying “it’s too late”. Some doctors also know this. I always hated seeing a woman who was at the most difficult part of her labor have to fold her self into a very uncomfortable position and have needles stuck in her back while she “held very still” instead of moving around or getting in a tub of warm water, which might have been just as helpful. I was also annoyed with the doctors (usually anesthesiologists) who told my patients who were wise enough to check it out before labor that epidurals were totally safe. My reply to that was if they are totally safe why do they have to put you on a continuous fetal monitor and take your vital signs every 5 minutes, put oxygen on you, have an IV in place. The most important part of epidural-ology is that it relaxes the pelvic floor muscles. This changes the shape of the birth canal making it more likely that they baby will roatate the wrong direction and either get stuck sideways or facing up (both more difficult positions to push a baby out). Add that to not having the urge to push, being told to push too soon and not being able to push effectively (physiologically) and you end up injuring or tearing the supporting tissues (read later bladder problems, needing a forcep delivery or a cesarean.

    As for risks in over 3000 births I never saw a women have a cardiac arrest or actually be unable to breath. I occasionally saw unintended spinal anesthesia if the epidural sac was penetrated or torn. This was usually discovered by the “test” dose of medicine, which produced too much anesthesia. I saw a lot of women (usually with epidurals for cesarean sections, who THOUGHT they couldn’t breathe because they couldn’t feel them selves breathing. If they are still talking, they are still breathing. I did see one mother who became paralyzed, most likely due to a reaction to the medication. These are VERY rare things but they do happen and they might make you want to reconsider trying the tub or a little more narcotic first. I did see women with spinal headaches, but since I had one of those myself without any anesthesia, I could usually fix those with fluids or as a second resort, get the anesthesiologist to do a “Blood Patch” to repair the leak. What I saw the most often were baby’s whose heart rates crashed and didn’t come back up and so the mother ended up with a STAT cesarean section…a big price to pay for pain relief…. And I saw a lot of women who did not get the pain relief they expected because a nerve did not get covered or the epidural didn’t work because the catheter that is usually placed did not go into the right place. I saw some mothers who got overloaded with fluids in preparation for epidurals or Cesarean Sections, not a big problem but uncomfortable swelling.

    Mostly, I think women need to know that whether they are 2 cm or 9 cm if they look like, and feel like they are in transition, the probably are and the don’t have much longer to go. They might want to do a few other things to relieve pain before going for epidurals. I could also talk about when epidurals prevent cesareans and save mothers and babies. But that’s for another time
    Bethany Hays, MD

    • yourbabybooty

      Thanks Dr. Hays. Definitely great things to keep in mind! Your insight (and wisdom) are so appreciated:)

  • Trish Tinser

    Really helpful info here. I’m not sure what I want to do yet, but I’m learning lots about all of it. I’ve showed this interview to a few of my friends & neither had learned this info from the birth class. I’m so glad Steve reached out to me on Facebook- thanks Steve!

    • yourbabybooty

      Steve says “you’re welcome!” :) So happy this is helpful for you!