The truth about epidurals

Some women wouldn’t give birth without one, while others want their labours drug-free. Whether or not an epidural is in your birth plan, it’s worth being across what this pain relief measure entails because births don’t always go to plan.

According to the latest figures, about one in five Australian women will have an epidural during labour for vaginal births, with additional ladies having the needle for caesarean births.

While the benefits of epidurals with caesareans are considered big, opinions vary on whether they’re all that good
for women wanting a vaginal birth.

Choosing whether or not to have an epidural during labour is a highly personal decision. But here are some facts to help you decide if an epidural is right for you.

An epi-what?

An epidural is a procedure performed by an anaesthetist in which anaesthetic is injected into an area near the spinal cord called the ‘epidural space’. It is used to relieve pain during labour and prior to caesarean births.
A skilled anaesthetist can control the amount of pain relief or numbness a woman receives, ensuring she maintains some feeling and movement.

What happens?

Before the epidural is administered, an intravenous drip is inserted into your arm as a precautionary measure,
should your blood pressure drop and you require fluids. The anaesthetist will then ask you to sit hunched forward or curled up on your side to provide better access to the right site.

Local anaesthetic is first injected into the back, before the epidural needle is inserted into the gap between two vertebrae to reach the epidural space. This is the most uncomfortable part of the procedure. You may feel a pushing sensation, but it should not hurt.

The epidural needle is used to insert a long, thin catheter and is then removed. This catheter allows delivery of the anaesthetic and top ups, if required.

This entire procedure takes around 10 to 20 minutes, and the medication will take a further 5 to 20 minutes to become effective. How long its effects last depends on the strength of the anaesthetic used.

The good stuff

The overwhelming advantage of an epidural is the pain relief. And for some women, it’s the relief from pain that allows them to not only enjoy their labour, but to relax enough to have a quicker birth (stress can be a factor
in lengthening a labour).

For women having caesareans, the big advantage of epidurals (as opposed to general anaesthesia) is the ability to stay awake to experience the birth.

The not-so-good stuff

With any medical procedure there are risks. For epidurals these include:
❋ Being restricted to bed, as the epidural anaesthetic can weaken your legs
❋ The chance of needing a catheter to empty the bladder, as some bladder sensation may be lost
❋ An increased chance of intervention and an assisted birth (the use of forceps or vacuum extraction for delivery), as the anaesthetic may interfere with your ability to push properly
❋ Slowing down the labour due to a range of possible factors, including hormone interference
❋ Severe headache, which can last for days or weeks and may require specific treatment, is reported by about one per cent of women who receive epidurals
❋ ‘Pins and needles’, numbness or weakness can sometimes persist after an epidural – in about one in 10,000 this may be long-lasting or even permanent
❋ The effects of the epidural may spread higher than intended and cause difficulty with breathing or, very rarely, unconsciousness.

A tale of three births

Holly, mother of three children aged six, four and three months, had epidurals with two births and a drug-free birth with her last.

“With my first baby, I was dead-set on having a natural, drug-free birth, but nothing went to plan!

My waters broke but I didn’t go into labour, so they induced me, stepping up the drugs when still I didn’t dilate fast enough.

Three hours in, after a seven-minute contraction and news I still wasn’t dilating, I screamed for an epidural. The pain of this labour was a shock.

Once I had the epidural, I was able to completely relax and, as I like to say, I ‘opened like a flower’. My beautiful daughter was born without any forceps or other assistance within four hours of having the needle.
With baby number two, once again I was induced. This time I’d given up on a natural birth, and a couple of hours after induction, I welcomed the epidural.

To my disappointment it only worked on one side and dropped to my knees, meaning I couldn’t walk, even well after my son was born. But I was able to feel the birth and felt like I had more control and could work with my body.

My last baby was also induced. But this time the induction drugs only stayed switched on for 30 minutes because I responded rapidly. I was able to give birth without an epidural after just three hours of labour. It was an empowering experience, even if harsh and gritty in the middle of it, but a great feeling at the end.

There’s no denying that my preference was the last, super-short labour for which I needed little intervention and could walk to the showers straight after. But I loved all my births and wouldn’t change a thing.”

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* Epidurals: Your questions answered
* Picking your pain relief