Should I just have the Epidural? Managing the sensations of childbirth by Gina Potts
Most of us have had other women tell us: 'oh, just have the Epidural!', 'why wouldn't you have it?' But have you found yourself saying to them, or yourself: 'I'm not sure I want it', or asking: 'what happens when I have one?' or 'what effect will it have on baby?' or 'how will I manage the sensations of childbirth?' In this blog, Gina takes a look at Epidural. What it is. What it does. The Pros. The Cons. And The Alternatives.
Epidural: what is it and how does it work?
Epidural is an anaesthetic which is used for pain relief during childbirth, as well as during some surgerical procedures, including c-sections. Epidurals are administered by injection into the spine and this is always done by an anaesthetist in the hospital. When a woman decides to have an epidural during childbirth, she will first be put on a drip, sited in the arm, so that she can be given fluids during the epidural. Then she will be asked to be in a leaning forward position, or lying on her side. A local anaesthetic will be used to numb the skin where the injection will be given. A needle is then placed between the vertebrae of the spine, usually in the lower part of the back, in order to insert a plastic tube called an epidural catheter. The catheter is left in whilst the needle is removed. A line is then inserted in to the catheter which delivers the epidural drug into the woman’s body. The pain relief effect is usually reasonable quick, taking full effect in about 20-30 minutes.
Epidurals can be delivered in differing dosages, having more or less pain-relieving effect. The higher dose will numb most of the lower half of the body and it won’t be possible to stand. A lower dose epidural can be used, which is called a mobile epidural, and this provides a lower level of pain relief whilst allowing the woman to have use of her legs and to move around. Regardless of the dosage, the woman will need to be attached to a monitor. The monitor needs to be strapped around the woman’s tummy throughout the labour. This is in order to keep track of how baby is handling the labour and the drugs being administered, and also to detect when contractions are happening. Both wired and wireless monitors are now available, and the wireless ones make it easier for a woman to move more freely.
What are the pros and cons of Epidural?
Epidurals provide effective pain relief, but do impact upon the progress of the labour. Because epidural relaxes the muscles, and the uterus is a set of muscles, it can make labour less efficient. So epidural can cause labour to be longer. The woman is less likely to feel the sensations of her contractions, so the midwife or doctor may need to coach her to push when the monitor indicates contractions are happening. Coached pushing may be more forced than mother-led pushing, so tearing may occur as a result.
The benefit of epidural is that it is an effective form of pain relief, including partial or complete loss of sensation in the whole lower half of the body. The woman would not feel the contractions or urges to push. It also enables a woman requiring a c-section to have no sensation, whilst remaining awake during the whole procedure. The woman is then able to receive her baby immediately once baby emerges.
Risks and side effects of epidural may include: discomfort when the needle and catheter are inserted, numbness in the chest and stomach areas and also in the legs, the legs may not be strong enough to stand where a high dose is used, low blood pressure, light-headedness, nausea, loss of bladder control, itchiness, headaches, temporary or permanent nerve damage, labour can be slow and less effective, higher occurrence of emergency c-section, baby may be less alert than usual at birth and baby may take longer to effectively breastfeed, other more serious effects and complications that should be discussed with your medical care provider.
What are the alternatives?
Many women choose to avoid having an epidural due to the implications it can have for both mum and baby. Learning about the physiology of childbirth is useful. Understanding why you are experiencing certain sensations can help you embrace, rather than resist, what you are feeling as you birth your baby. You may dedice to prepare yourself with tools to help you manage the sensations of childbirth. Different labour and birth positions can make birthing easier. Relaxation techniques and using breathing can help your body ease into the sensations, and allow your baby to emerge more gently. Things like massage, reflexology, aromatherapy and other alternative therapies can help you to maximise your feelings of relaxation and calm. If your body is relaxed and free of tension, the birth will be easier. Being supported by a caring and supportive birth partner, together with a birthing environment that helps you feel safe and secure can also help your birthing to progress smoothly and gently. These are all things that hypnobirthing courses cover.
Whatever you decided to do, make sure you educate yourself before your baby's birthing day. Making informed decisions helps to make the birth experience much more positive regardless of the route you choose.
Gina Potts is Director of ZenBirth UK. She comes from an academic research background, focusing on women's history, writing and feminism. Since 2009 has spent much of her time researching into all aspects of maternity care, pregnancy, birth and women’s postnatal health. In 2011, she founded ZenBirth and has helped hundreds of couples have a positive birth experience.