• The Fit Midwife

Epidurals.... Your Uterus, Your Choice!

Epidurals… One of everyone’s favourite things to demonise. Have we all become so obsessed with natural birth that any form of pain relief is the work of the devil? It sometimes feels that way.

When women come in to the labour ward many of them have birth plans that do not include any pain relief except hypnobirthing techniques or the use of water and active positioning. I love this. I am all for active, physiological birth. I think that if your method of coping comes on a CD of a lady whose voice soothes you (and so often your midwife when it is 3am and the room is dark) then let’s crack on.

So if we are all about advocacy and choice as we all so often preach then why do women feel like choosing an epidural is a failure. Like they have tried in some way to reach an imaginary bar that is set by the perception that birthing without pain relief is the only way to birth? It is a little bit soul destroying to hear a woman apologise to her partner because she is choosing the epidural. Being so disheartened when she says “Nikki, I really didn’t want to have this epidural. I can’t believe I couldn’t do it”.

If you know me you can imagine my response to this….

“Choosing an epidural is NOT the easy option. It categorically does NOT mean you have failed.” (Perhaps said with slightly more colourful language and with a slight Geordie sounding twang!)

Let’s chat for a second about the difference between NEED and WANT. If we are being literal and following dictionary definitions a ‘need’ is something essential required to survive. A ‘want’ is something you do not need to survive but you would like to have it.

But how about we be realistic and apply this to childbirth. Let’s change the context of survival. In this case surviving your current situation and enabling you to have the best possible birthing experience. If you do not wish to feel the pain of contractions and you need the epidural to survive this part of your pregnancy journey then I am absolutely more than happy to oblige. I have no idea what you feel. What anguish you are experiencing mentally or physically. All I want to ensure is your choice is an informed choice.

I want you to remember all the hormones flying around your pregnant bodies. When you are in labour, pain can cause excessive feelings of fear, anxiety, stress or feeling unsafe in some women. And this then releases catecholamines. These are the body’s stress hormones and they prevent the release of oxytocin. Which is your happy, labour hormone. This can then stall labour and we all know what can happen if labour stalls…. (enter Doctors and Drugs).

We absolutely should not judge others for what they want; some women want an epidural from the get go for personal reasons. Or for what they need; many cardiac patients are required to have epidurals to reduce stress on their heart and many women simply need an epidural to ensure their best birthing experience. What’s best for one is not best for all. Especially in pregnancy.

Now to my favourite topic and constant recurring theme….. Informed Choice!!! I have noticed that the practice here in the UAE is to push epidurals on women. The reasons are beyond me. I think most physicians do it to make their own life easier. It certainly doesn’t always make the woman’s life easier. There is a tendancy to completely skip discussing all the risks associated with an epidural. And whilst they are rare you should not be making a decision about having a needle place a tiny plastic tube in your spine without knowing all the information!

So with this in mind I have taken some information from the Obstetric Anaesthetic Association, who have the best information card for antenatal education and a lot more information (found here http://www.labourpains.com/home)

Setting up your epidural:

Once you decide that you want an epidural please understand that it will not happen straight away. Sorry to be the bearer of bad news. But we need to call the anaesthetist. They need to talk to you. Consent you. We need to prepare you. Yep, this will suck big time if you are at the end of your tether but swearing at us won’t really speed the process up (just FYI).

· You will need to have an intravenous cannula and a drip – usually in your hand.

· While the epidural is being put in, it is important that you keep still and let the anaesthetist know if you are having a contraction. This is so important considering there will be a needle in your back. It is in the epidural space, any further and it becomes a spinal anaesthetic.

· The needle does NOT stay in your back, it is merely used to introduce a tiny, thin plastic catheter which is how you get the good drugs. (See pictures below)

· Usually takes 20 minutes to set up and 20 minutes to work.

· Some epidurals do not work fully and need to be adjusted or replaced.

Advantages of an epidural

· Usually provides excellent pain relief.

· Sometimes a spinal is given first for a quicker effect.

· The dose or type of local anaesthetic can sometimes be altered to allow you to move around the bed. This is a low-dose (or mobile) epidural.

· In general epidurals do not affect your baby.

· Can be topped up for caesarean section if required.

Possible problems with your epidural

· Repeated top-ups with stronger local anaesthetic may cause temporary leg weakness and increase the risk of forceps or ventouse delivery due to loss of sensation in .

· The epidural may slow down the second stage of labour slightly.

· You may develop low blood pressure, itching or a fever during the epidural.

· The epidural site may be tender but usually only for a few days.

I feel like I have to really point this out because the misconception annoys me greatly….. Backache is NOT caused by epidurals but is common after any pregnancy. If your mum/sister/bestie tells you that her permanent backache was caused from her epidural, then well… they aren’t exactly right. Pushing a baby the size of a watermelon out of your body means that your pelvis and especially lower back is stressed and strained. This is normal and this can cause post birth back pain. A very good PN exercise trainer can remedy this for you!

The table below outlines the risks that are associated with epidurals. You should be told these before anyone goes near your back….. Make sure you are aware of them if epidural is something you may consider…..

So there you have it. All the information needed to make an informed decision. Hopefully a bit of insight in to why some women have epidurals. And a whole load of rational reasons why we should not be judging how other people choose to birth their babies. All I ever want to hear is women congratulating each other on how strong they were, regardless of the situation!

I want to hear more women proud of their epidural birthing experience and not have to follow up with a justification after disclosing their choice of pain relief! We cannot preach choice and empowerment if women still feel judged for their choices. Besides we are judged on so much everyday, let’s just be a little kinder to each other!

Nikki xxx

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