Epidurals are brilliant pain relief, but they’re not without drawbacks. There are subtle differences to the epidural and spinal blocks, and each has different instances where they’re used, but for the purpose of this blog I have lumped them in same basket.
Firstly let me say that the decision on whether to have an epidural is a personal one. If you’re not planning on one going in to labour but then up having one, for whatever reason, you have not ‘failed’. If you’re set on having one from the first contraction, then that is absolutely your choice. No-one should be judged on what happens during their birth. But I do strongly believe that parents need to have all the information about any pain relief option they choose so that they can make fully informed decisions. I also strongly advocate for people to learn this information during pregnancy, not be hearing it for the first time in the birth suite (which is why I’m such a strong believer that every pregnant family should receive independent childbirth education!)
If you’re on the fence about what comfort measures and pain relief options to use, then you’re best to work up to the epidural, since it’s a final decision – not typically reversable. I explain this by referring to the epidural as the ‘ten’ of the labour coping/pain relief world, with other comfort measures and pharmaceutical options appearing at different points of the scale from 1-10. Alternative methods of coping and pain relief to consider having first include:
- Use of warm water (shower/bath)
- TENS machines
- Sterile water injections
- Counter pressure and massage on the lower back/pelvis
- Rebozo application
- Movement (walking/swaying/rocking on a yoga ball)
- Pethidine injections
- Nitrous oxide (gas and air/laughing gas)
- Birth doula – studies have shown that having a birth doula at your birth results in a 30% reduction the use of analgesia and specifically a 60% reduction in epidural use. Check out my blog on how to budget for a doula.
One other thing to keep in mind is potential problems with the application of the epidural. It may take multiple attempts by the anaesthesiologist to get correct placement, it may provide incomplete coverage (only getting relief on one side of the body or having ‘holes’ where contractions are still felt) or severe headaches during the early postpartum period as a result of a dural puncture.
Epidurals can be very beneficial if a birthing parent is approaching exhaustion, or are holding conscious or subconscious tension in the pelvis/pelvic floor which may be stopping labour from progressing.
The infographic above lists some of the main ‘cons’ of having an epidural. But by asking questions and discussing epidurals during pregnancy with your care providers some of the cons can be mitigated by:
- Having an ‘upright epidural’ – eg kneeling facing the back of an upright bed
- Having assistance to change positions periodically – eg lying on your side, rather than your back, and changing sides every 30-45 minutes.
- Using a peanut ball to assist in leg positions to keep the pelvis open – check out the Lamaze blog Peanut balls for labour
The upright epidural utilizes gravity to assist with baby’s decent through the pelvis. The assisted position changes and open pelvis may help mitigate the problem of being stationary with an epidural. Movement helps baby descend into and navigate through the pelvis. Without movement, a baby may descend very slowly or not at all, resulting in a longer labour, a fatigued baby which may show signs of foetal distress, and need for further intervention like assisted vaginal delivery or an emergency caesarean surgery.
As always, ask the BRAIN questions (see my blog Have you got your BRAIN?) about any interventions you’re considering or are offered. With careful considerations as to what other comfort you’ll use, it is absolutely possible to get through labour without an epidural. But if you choose to have one they can be of great benefit and with planning and discussion with our care provider, some of the drawbacks can be mitigated.
Rachel Angelone is the founder of Your Birth Your Baby and is a Lamaze Certified Childbirth Educator, Postpartum Doula and NurtureLife Pregnancy Massage Practitioner based in Melbourne. Rachel offers independent childbirth and early parenting education to pregnant families before baby arrives. Once your baby is Earth-side, she offers practical and emotional in-home support as you adjust to your new life as parents. Along both journeys she can provide relaxing and restorative massage treatments. She is also a loving wife and mother to two young girls.
Cover photo by Seif Eddin Khayat on Unsplash