Epidurals: Are they for me?
If you’re expecting, I’m sure you’ve started wondering how you’re going to cope during labour and birth! If pain is a fear of yours, you may want to start learning if an epidural is the right choice for you and your baby.
Epidurals are an excellent and safe option for pain relief in the active stage of labour – over fifty percent of people in labour choose to have one(1). However, it is important to weigh the benefits vs the risks for you and your baby. Though the risks involved may appear to overshadow the benefits on paper, the pain relief and comfort provided can outweigh the risks for some people onc they receive it. Regardless, it’s important to educate yourself ahead of time, so you can truly have informed consent in the moment!
Let’s take a closer look at the Benefits vs Risks of an Epidural. This is not an all-inclusive list and it’s still important to speak with your doctor about the risks that apply specifically to you.
Benefits:
Excellent source of pain relief
Chance to rest before pushing
More moms say they are satisfied with their birthing experience 2,4
Risks:
Possible low blood pressure, fever and urinary retention4
Nausea & vomiting (vomiting is common without an epidural as well)4
Risk of post-dural puncture headache (a terrible headache after your epidural is inserted)5
Higher need for Pitocin to be administered 2,4
Unable to get out of bed once inserted and more difficult to move around and change positions 4 though some hospitals offer “Walking” or “Low-dose” epidurals which allow for easier movement.
It can slow down or stall labour in the second stage, which could result in a longer labour 2
An incomplete block can happen where the epidural only works in patches or only half of your body – this can happen to 1 in 10 people and can make coping a huge challenge
Higher risk of assisted birth (vacuum or forceps) which can lead to tearing 2 but this may be improving as more modern epidural techniques are being used with less medication so you can feel more while pushing4
The medications often have a side effect that makes you feel itchy
There is a risk of the medication crossing the placenta and getting to baby which may or may not affect breastfeeding3 but evidence shows there are no higher risks of neonatal admissions or cesarean rates 2,4
The amount of IV fluids you are given can increase which causes swelling and possibly delayed onset of mature breast milk production.
Can decrease the body’s response to the transition phase in labour which sends hormones to help baby’s transition to the outside world easier.
You will need a catheter to empty your bladder every 2 hours – increasing the risk of a bladder infection.
So, you think an epidural may be for you? Want to know what to expect?
It’ll go something like this..
You tell your nurse that you’d like an epidural or you are given the suggestion based on how you are coping. Your nurse will notify anesthesia that there you would like one – this can take time if the Anesthesiologist is with another patient in surgery or a procedure, so don’t hesitate to ask if you are sure you want one! You will need to have an IV inserted in your hand or arm by your nurse. An anesthesiologist will come to insert your epidural and your nurse will assist and guide you through the process. You will be positioned sitting on the side of the bed and curled around a pillow, arching your back like a cat with your chink tucked to your chest. They will clean your back with a cold antiseptic solution to reduce your risk of any infections. Most importantly, you will be asked to stay very still.
As you can imagine, staying still while having contractions can be quite difficult, but you will be coached and supported through the time it takes to insert the epidural catheter in the right position in your back. From there, the anesthesiologist will inject freezing which burns a bit and is often the worst part. After that, they will insert the epidural needle; this feels like strong pressure on your back but shouldn’t hurt as you will be frozen. The needle is removed (there is no needle left in your back) and you’re left with a tiny tube called a catheter that will be securely taped up your back and over your shoulder. The tubing is attached to an IV machine that will slowly and constantly deliver the medications to keep your epidural working and help relieve your pain.
After you have your epidural inserted, your nurse monitor you and your baby closely. You will also have a urinary catheter inserted (one that stays in or one they put in every 2 hours) to help empty your bladder because you won’t be able to feel when you need to pee. This is often inserted after your epidural so it is less uncomfortable. After a few minutes, you will likely be feeling relief and be able to rest for a bit until baby is ready to make their arrival! And if you’re not, tell your nurse!
Epidural isn’t for you? You still have options!
Not to fear, there are alternative pain relief options! Many parents choose to try other methods such as narcotic pain medications or nitrous oxide (laughing gas). There are also many more “natural” strategies such as massage, acupuncture or acupressure, aromatherapy, water, or music therapy, using breathing techniques and different positions, and even hypnobirthing6
This is important…
Your epidural will not always work the way you imagine. For many epidurals will remove the sensation of squeezing from the contractions, but for 1/10 people it will not work or will only partially work. This can be a huge deal when you feel like you’re gotten to the point of needing “the big guns” for pain relief. Make sure you have mental coping strategies to get you through this if it happens.
Also, knowing that it is NORMAL to feel a LOT of pressure when its time to push is essential. Your contractions will be reduced to the point of barely, if not complete, relief but when baby is low enough you will still feel a lot of pressure when they are crowning. This can be a real shock for some people and also hard to handle after a period of relief from it.
But, most importantly…
ensure you have a good support system and birthing team by your side! One of the best things you can do is take a prenatal class – like Empowered Birth. Being informed will help you feel more prepared for childbirth and aware of the options and things that come up during it and after. Remember that it’s important to have an idea of how you want your birth to go, knowing what is “normal” / expected and also knowing that babies have their own plan on how to enter the world – sometimes we adjust to their needs in the moment. In the end, you will make the best decision for you and your baby!
I hope this has helped answer some of your questions and made you feel more empowered and excited for your birth! Make sure to discuss this with your OB if you have further concerns or questions. References: