If you’ve had a baby, two big questions you can be sure to get from (mostly female!) family and friends are:
– what kind of delivery did you have?
– if answer to previous question is normal delivery then… did you have an epidural?
Anyone that knows me knows that I am not the biggest fan of epidurals. However, I am not writing this to give my opinion or tell you what to do or what not to do. In fact, whether you have an epidural or not is your business and you should not feel the need to justify your decision. I want to just give you the information so you know the full story about epidurals – the good, the bad and the ugly!
What Exactly Is An Epidural?
Surprisingly to some people, an epidural is not an obstetric procedure. It is carried out by an anaesthetist. This is why, although available in all maternity hospitals in Ireland, you may have to wait if there is an emergency in theatre for an anaesthetist to become available to do it. I found this video of an anaesthetist explaining the epidural procedure on youtube that it far better than I could type it!
Video copyright of http://www.StreamingWell.tv
A brief history of the epidural. They first started to exist as far back as the 1890’s. They were first used in childbirth in the 1940’s but only became commonly used in childbirth in the 1970’s. Some of the reasons for this are that epidurals commonly slowed down labour and in the 1970’s the medicalisation of birth really took hold with increased hospital births, the use of oxytocin to speed up contractions, continuous fetal monitoring and improved safety and competence in Caesarian Sections. Can you see the cascade of interventions there in that last sentence? Advances in medical science can help and hinder us; undoubtedly lives have been saved thanks to Caesarian Sections and other interventions in normal birth. Equally, many women have undergone unnecessary interventions and procedures in birth that have left them damaged, physically and emotionally, for the rest of their lives.
I don’t know how many times I’ve heard the analogy “you wouldn’t get a tooth out without pain relief so why wouldn’t you have an epidural for childbirth?” I guess it depends on your outlook though, having a tooth extracted is painful – as is childbirth. Yet, the person getting the tooth out has no involvement in the procedure, they just sit there and let the dentist pull it out. In childbirth, unless you are having a C Section, you are very active in the process; most women do not want to have the baby “pulled out”. There’s the difference.
Epidurals in labour have been researched and researched as it is such a hot topic in maternity care. Epidural rates are higher than ever, figures have doubled over the past 20 years. I think midwives need to be accountable here too. We, as professionals, can impact these figures. If we provide good one to one care and support a woman well in labour, evidence has shown that the epidural rate is reduced. I think if women are informed more about epidurals BEFORE labour, they can make a more informed choice when the time comes.
I have a little infographic that summarises all the risks and benefits at the end of this post if you want to save it for later use. I’ll start with the benefits of an epidural. If you are finding that you are just not coping with labour, despite trying all the other options and techniques, then an epidural will usually give you excellent pain relief. If you have an overwhelming fear of childbirth and an epidural is the difference between you having a normal birth or a C Section then an epidural may be the answer for you. An epidural is also beneficial in women with raised blood pressure – either essential hypertension, gestational hypertension or pre-eclampsia; as it lowers blood pressure. In a prolonged labour, it can give the labouring woman a rest. In an induced labour, it can help a woman cope with the more intense pains brought on by syntocinon / oxytocin. However, some women cope fine with induction so don’t presume you will need an epidural just because you are having your labour induced.
So on to the risks of an epidural. Usually in your pregnancy you will receive a little leaflet or booklet on pain relief in labour. You will more than likely add this to the big pile of other pregnancy related leaflets you acquire that you have great intentions of reading but other things get in the way. If you were to read this leaflet, you will see under the epidural part that the risks are usually listed as anaesthetic risks such as lowering of blood pressure (IV fluids can counteract this), headaches, back pain, heavy tingling legs, nerve damage (rare). Obviously these are important but the more serious risks are rare as anaesthetic techniques constantly evolve and improve. What might not get as much of a mention are the obstetric risks and side effects. The pushing stage of labour is usually slightly longer with an epidural and you are more likely to need a forceps delivery and therefore an episiotomy. You might still feel pain as sometimes it doesn’t work or it only works on one side. Your baby is more likely to be in a poor position for delivery which also increases the risk of instrumental or operative delivery. You will be confined to the bed for your labour, delivery and around 6 hours after delivery. You will need a catheter in your bladder which increases your risk of urinary retention. Epidurals lower natural production of oxytocin hormone usually resulting in the need for syntocinon infusion. Mothers are more likely to have a high temperature in labour with an epidural; this can lead to problems for the baby such as poor condition at birth. There is also recent research that links epidurals to problems with breastfeeding and higher rates of jaundice. Please contact me at firstname.lastname@example.org for further information or details of research and studies to support this. Also some hospitals over mobile epidurals which I haven’t covered here as there is limited availability, if any, in Ireland at present.
A Final Thought
As a midwife, I would never advise a woman not to have an epidural. If it is requested, I try to organise for it to happen as soon as possible. That moment is not the time to be getting into a detailed discussion about the pros and cons of epidurals. The anaesthetist performing the procedure briefly discusses it and obtains consent. What astounds me is the power of the mind. These women are in so much genuine distress with contractions that they request an epidural then manage to stay perfectly still for the 10-20 minutes it might take for the procedure to be completed. If that doesn’t demonstrate mind over matter, I don’t know what does. This brings me on to an alternative to epidural (or any other medicated pain relief) – that is hypnobirthing. I am not trained to teach hypnobirthing and I can only say how good it is from seeing women use the technique in front of my own eyes. These are the women that look like they have had an epidural; these are the women that you examine to find they are 10cm / fully dilated and are acting like they are in the very early stages of labour. It has to be seen to be believed. So I have asked a lovely lady who is an expert in this and teaches it to do a guest post on my blog about it, you can read it here. So did I have an epidural? None of your business… only messing, you can read about what happened in my labour here.